Provider Demographics
NPI:1679208466
Name:EYE SPECIALIST LLC
Entity type:Organization
Organization Name:EYE SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE Y DUENO
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ MALDONADO
Authorized Official - Suffix:SR
Authorized Official - Credentials:OD
Authorized Official - Phone:787-858-2624
Mailing Address - Street 1:CALLE 5A MARGINAL K1
Mailing Address - Street 2:URB VILLA REAL
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-858-2624
Mailing Address - Fax:939-440-9369
Practice Address - Street 1:CALLE 5A MARGINAL K1
Practice Address - Street 2:URB VILLA REAL
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-858-2624
Practice Address - Fax:939-440-9369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty