Provider Demographics
NPI:1861531816
Name:OPTICA DE LA CRUZ INC
Entity type:Organization
Organization Name:OPTICA DE LA CRUZ INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:787-767-2221
Mailing Address - Street 1:1060 CALLE BRUMBAUGH
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925-2914
Mailing Address - Country:US
Mailing Address - Phone:787-765-4028
Mailing Address - Fax:787-767-2221
Practice Address - Street 1:1060 CALLE BRUMBAUGH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-2914
Practice Address - Country:US
Practice Address - Phone:787-765-4028
Practice Address - Fax:787-767-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR024156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty