Eye Care Boutique LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

EYE CARE BOUTIQUE LLC

Practice address

Carr. 129 KM 9.1
Hatillo, PR 00659

Phone

(787) 930-2035

NPI assigned

Jul 26, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Adiannette Gonzalez Rodriguez

Title

Owner

Phone

(787) 930-2035

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Adiannette Gonzalez, O.D.

  • Optometrist
  • Hatillo, PR
  • NPI 1073842613
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693872000000",
    "number": "1083395867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HC 5 BOX 34600",
            "city": "HATILLO",
            "state": "PR",
            "postal_code": "006599798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARR. 129 KM 9.1",
            "city": "HATILLO",
            "state": "PR",
            "postal_code": "00659",
            "telephone_number": "787-930-2035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CARE BOUTIQUE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-26",
        "last_updated": "2023-09-05",
        "certification_date": "2023-09-05",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ RODRIGUEZ",
        "authorized_official_first_name": "ADIANNETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "787-930-2035"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Hatillo, PR
• Providers in Hatillo, PR by specialty
• Optometrist in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.