Provider Demographics
NPI:1144543836
Name:VISION 2000 EXPRESS LUQUILLO CORP
Entity type:Organization
Organization Name:VISION 2000 EXPRESS LUQUILLO CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GIAN
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:MURATI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-786-2000
Mailing Address - Street 1:50 ISABEL II STREET
Mailing Address - Street 2:EDIF. JOAQUIN MONTESINO
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-786-2000
Mailing Address - Fax:787-798-1895
Practice Address - Street 1:50 ISABEL II STREET
Practice Address - Street 2:EDIF. JOAQUIN MONTESINO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-786-2000
Practice Address - Fax:787-798-1895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR195152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0058128OtherCMS
PRU63246Medicare UPIN