Provider Demographics
NPI:1215034749
Name:DAVILA, ROBERTO (LIC OPTICIAN DO)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:DAVILA
Suffix:
Gender:M
Credentials:LIC OPTICIAN DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:REPARTO SAN JOSE ALMAGRO ST 388
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-1245
Mailing Address - Country:US
Mailing Address - Phone:787-531-2777
Mailing Address - Fax:787-763-5667
Practice Address - Street 1:REPARTO SAN JOSE ALMAGRO ST 388
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-1245
Practice Address - Country:US
Practice Address - Phone:787-531-2777
Practice Address - Fax:787-763-5667
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR011156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician