Provider Demographics
NPI:1992157119
Name:LENS OUTLET
Entity type:Organization
Organization Name:LENS OUTLET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:TORRES-MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:OP
Authorized Official - Phone:787-844-0346
Mailing Address - Street 1:VALLE VERDE
Mailing Address - Street 2:769 CALLE RIACHUELO
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-844-0346
Mailing Address - Fax:
Practice Address - Street 1:BOULEVARD LUIS A FERRE 2165
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0725
Practice Address - Country:US
Practice Address - Phone:787-844-0346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR822261QH0100X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR037879001Medicaid