NPI: 1083964043 · TOA BAJA, PR 00949 · Eyewear Supplier · NPI assigned 09/17/2012
| Authorized Official | SERRANO, KYLMARIE (HEALTH & WELLNESS REGIONAL DIRECTOR) |
| NPI Enumeration Date | 09/17/2012 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 1,322 | $28K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| V2020 | Frames, purchases | 559 | 306 | $19K |
| V2100 | Sphere, single vision, plano to plus or minus 4.00, per lens | 382 | 208 | $6K |
| V2750 | Anti-reflective coating, per lens | 306 | 154 | $3K |
| V2744 | Tint, photochromatic, per lens | 27 | 16 | $410.00 |
| V2103 | Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens | 48 | 21 | $213.00 |