Organization Active NPI

Optica Sur LLC

  • Optometrist
  • Salinas, PR
National Provider Identifier
1962010876
Registry record updated Jul 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
OPTICA SUR LLC
Practice address
Portofino Plaza #2
Salinas, PR 00751
Phone
(787) 944-9525
NPI assigned
Jul 16, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2020

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

Authorized official

Name
Dr. Ricardo Gonzalez Lebron, ODNPI 1427372069
Title
Optometrist
Phone
(787) 944-9525

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

Portofino Plaza #2
Salinas, PR 00751

Mailing address

30 Urb Terra del Valle
Cayey, PR 00736-3245
Phone (787) 674-5070

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240619000495 PR Part B Supplier - Clinic/Group Practice 3779026794 Receives reassigned benefits from 1 practitioner
Practice locations: Salinas, PR

National Provider Directory

National Provider Directory

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1594857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594857600000",
    "number": "1962010876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 URB TERRA DEL VALLE",
            "city": "CAYEY",
            "state": "PR",
            "postal_code": "007363245",
            "telephone_number": "787-674-5070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PORTOFINO PLAZA #2",
            "city": "SALINAS",
            "state": "PR",
            "postal_code": "00751",
            "telephone_number": "787-944-9525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTICA SUR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-16",
        "last_updated": "2020-07-16",
        "certification_date": "2020-07-16",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ LEBRON",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "787-944-9525",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salinas, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2020; 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.