E C Boutique Corp

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

E C BOUTIQUE CORP

Doing business as

EYE CENTER BOUTIQUE

Practice address

200 Ave Fragoso Suite 108
Plaza Carolina Mall
Carolina, PR 00983-3104

Phone

(787) 768-6666

Fax

(787) 769-6666

NPI assigned

Feb 17, 2011

Organization subpart

No

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

Authorized official

Name

Pedro David SalibNPI 1619281094

Title

President

Phone

(787) 768-6666

Specialties & licenses 3

Addresses

Other names 1

• EYE CENTER BOUTIQUE Doing business as

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

Tax ID family

E C Boutique Corp3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• E C Boutique Corp

  • Eyewear Supplier
  • San Juan, PR
  • NPI 1144086562
  NPD tax ID
• E C Boutique Corp

  • Eyewear Supplier
  • Bayamon, PR
  • NPI 1689973778
  NPD tax ID

Locations

Practitioners 2

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

• Pedro David Salib, O.D.

  • Optometrist
  • Carolina, PR
  • NPI 1619281094
  Medicare reassignment NPD Authorized official
• Jorge L Roldan, OD

  • Optometrist
  • Carolina, PR
  • NPI 1528114188
  NPD

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

{
    "created_epoch": "1297900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730073600000",
    "number": "1972800530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 PARQUE MEDICI",
            "address_2": "URB PASEO DEL PARQUE",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009266514",
            "telephone_number": "787-768-6666",
            "fax_number": "787-769-6666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 AVE FRAGOSO SUITE 108",
            "address_2": "PLAZA CAROLINA MALL",
            "city": "CAROLINA",
            "state": "PR",
            "postal_code": "009833104",
            "telephone_number": "787-768-6666",
            "fax_number": "787-769-6666"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 THE MALL OF SAN JUAN BULEVARD",
            "address_2": "SUITE 118 URB VILLA OLIMPIA",
            "address_purpose": "LOCATION",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009246514",
            "country_code": "US",
            "telephone_number": "787-507-5377",
            "fax_number": "787-731-5642",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "501 AVE WEST MAIN SUITE 1215",
            "address_2": "PLAZA DEL SOL",
            "address_purpose": "LOCATION",
            "city": "BAYAMON",
            "state": "PR",
            "postal_code": "009613867",
            "country_code": "US",
            "telephone_number": "787-780-4444",
            "fax_number": "787-780-4444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "E C BOUTIQUE CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-17",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-23",
        "status": "A",
        "authorized_official_last_name": "SALIB",
        "authorized_official_first_name": "PEDRO",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-768-6666"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "PR",
            "license": "135",
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EYE CENTER BOUTIQUE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinic/Center in Carolina, PR
• Providers in Carolina, PR by specialty
• Clinic/Center in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; 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.