Provider Demographics
NPI:1114072600
Name:FIRST OPTICAL CENTER
Entity Type:Organization
Organization Name:FIRST OPTICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-795-5109
Mailing Address - Street 1:PO BOX 3012
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-3012
Mailing Address - Country:US
Mailing Address - Phone:787-795-5109
Mailing Address - Fax:787-795-5109
Practice Address - Street 1:CENTRO COMERCIAL LOS DOMINICOS
Practice Address - Street 2:19
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-795-5109
Practice Address - Fax:787-795-5109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR186156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty