Deo PR Retail 1 LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

DEO PR RETAIL 1 LLC

Doing business as

deo

Practice address

Avenida de Diego
310 Plaza de Diego Local 102B
San Juan, PR 00909

Phone

(787) 776-8570

NPI assigned

Jan 21, 2020

Last updated

Oct 10, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

SHALEM CONSUMER BRANDSAs reported in NPPES

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

Authorized official

Name

Mr. Gustavo Andres Gautren

Title

Dir. of. Operations

Phone

(782) 429-6724

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• deo Doing business as

Electronic endpoints 1

Part of

Shalem Consumer Brands

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Shalem Consumer Brands

  dba deo eyewear

  • Eyewear Supplier
  • Carolina, PR
  • NPI 1578111043
  NPPES parent name

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

{
    "created_epoch": "1579564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696896000000",
    "number": "1881224673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "162 MONTAGUE ST APT 2",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112013506",
            "telephone_number": "646-512-0313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "AVENIDA DE DIEGO",
            "address_2": "310 PLAZA DE DIEGO LOCAL 102B",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00909",
            "telephone_number": "787-776-8570"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "270 PR-52",
            "address_purpose": "LOCATION",
            "city": "Caguas",
            "state": "PR",
            "postal_code": "00725",
            "country_code": "US",
            "telephone_number": "646-512-0313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DEO PR RETAIL 1 LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHALEM CONSUMER BRANDS",
        "enumeration_date": "2020-01-21",
        "last_updated": "2023-10-10",
        "certification_date": "2020-04-17",
        "status": "A",
        "authorized_official_last_name": "GAUTREN",
        "authorized_official_first_name": "GUSTAVO",
        "authorized_official_middle_name": "ANDRES",
        "authorized_official_title_or_position": "DIR. OF. OPERATIONS",
        "authorized_official_telephone_number": "782-429-6724",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1578111043",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.securepms.com/Account/LogOn?ReturnUrl=%2f",
            "affiliation": "N",
            "endpointDescription": "EMR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "plaza carolina",
            "city": "Carolina",
            "state": "PR",
            "country_code": "US",
            "postal_code": "009830098",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "deo",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "deo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Eyewear Supplier in San Juan, PR
• Providers in San Juan, 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 Oct 10, 2023; 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.