Provider Demographics
NPI:1043592439
Name:FAMILY OPTICAL CENTER INC.
Entity Type:Organization
Organization Name:FAMILY OPTICAL CENTER INC.
Other - Org Name:FAMILY VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SANTA
Authorized Official - Middle Name:ROMAN
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:787-864-6884
Mailing Address - Street 1:48
Mailing Address - Street 2:PLAZA GUAYAMA MALL
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-864-6884
Mailing Address - Fax:787-866-2626
Practice Address - Street 1:48
Practice Address - Street 2:PLAZA GUAYAMA MALL
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-6884
Practice Address - Fax:787-866-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR299261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center