Provider Demographics
NPI:1992075188
Name:NULOOK CLINICA VISUAL FAMILIAR C.S.P.
Entity type:Organization
Organization Name:NULOOK CLINICA VISUAL FAMILIAR C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:YARITZA
Authorized Official - Middle Name:JUDITH
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-949-5051
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-0218
Mailing Address - Country:US
Mailing Address - Phone:787-949-5051
Mailing Address - Fax:
Practice Address - Street 1:CARR 149 KM.63.8
Practice Address - Street 2:EDIFICIO CRUZ OFICINA 5
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-949-5051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR676152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty