KCM Optical Inc Eye Center Boutique

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

06222780019 Issued in PR

Legal business name

KCM OPTICAL INC EYE CENTER BOUTIQUE

Practice address

119 Trigal PLZ Ste 4
Manati, PR 00674-5518

Phone

(787) 884-5924

Fax

(787) 854-4407

NPI assigned

Sep 30, 2015

Last updated

Sep 30, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Othoniel Garcia Sr., O

Title

President

Phone

(787) 344-6192

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1443571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443571200000",
    "number": "1316317555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 CALLE TURIN",
            "city": "VEGA BAJA",
            "state": "PR",
            "postal_code": "006933604",
            "telephone_number": "787-884-5924",
            "fax_number": "787-854-4407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 TRIGAL PLZ STE 4",
            "city": "MANATI",
            "state": "PR",
            "postal_code": "006745518",
            "telephone_number": "787-884-5924",
            "fax_number": "787-854-4407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KCM OPTICAL INC EYE CENTER BOUTIQUE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-30",
        "last_updated": "2015-09-30",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "OTHONIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-344-6192",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "O"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "PR",
            "license": "06222780019",
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "PR",
            "license": "2015055550PUS076357",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Eyewear Supplier in Manati, PR
• Providers in Manati, PR by specialty
• Eyewear Supplier in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.