Provider Demographics
NPI:1447470943
Name:IQ OPTICAL INC
Entity type:Organization
Organization Name:IQ OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YADIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-286-6362
Mailing Address - Street 1:PMB 627
Mailing Address - Street 2:PO BOX 4952
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-286-6362
Mailing Address - Fax:787-286-6364
Practice Address - Street 1:PMB 627 BOX 4952
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726
Practice Address - Country:US
Practice Address - Phone:787-286-6362
Practice Address - Fax:787-286-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR455261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7260081OtherHUMANA PRIVADO
PR50468OtherPREFERRED MEDICARE CHOICE