Provider Demographics
NPI:1134742067
Name:DEO PR RETAIL 2 LLC
Entity type:Organization
Organization Name:DEO PR RETAIL 2 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIR. OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:ANDRES
Authorized Official - Last Name:GAUTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-429-6724
Mailing Address - Street 1:2019 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2946
Mailing Address - Country:US
Mailing Address - Phone:646-512-0313
Mailing Address - Fax:
Practice Address - Street 1:270 PR-52
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:646-512-0313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEO PR RETAIL 1 LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-27
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty