Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 494 | PR |
NPI | 1093229536 |
---|---|
Provider Name | Eduardo Velez Lara SR. |
First Address | Mayaguez, PR 00680 |
Second Address | Mayaguez, PR 00680-0068 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2017 |
Last Update Date | 11/12/2017 |