Provider Demographics
NPI:1881874857
Name:LEVITTOWN OPTICAL INC
Entity type:Organization
Organization Name:LEVITTOWN OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAHI
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIETO MATTA
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED OPTICIAN
Authorized Official - Phone:787-662-1572
Mailing Address - Street 1:PB-4 CARIBE ST
Mailing Address - Street 2:PARQUE PUNTA SALINAS
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-690-8093
Mailing Address - Fax:787-690-8926
Practice Address - Street 1:#9 DR ALVAREZ CHANCA AVE
Practice Address - Street 2:LOCAL A 5TA SECC LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-690-8093
Practice Address - Fax:787-690-8926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR621156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty