Provider Demographics
NPI:1295471183
Name:CLINICA VISUAL Y OPTICA DR. ROMAN ROMAN, INC
Entity Type:Organization
Organization Name:CLINICA VISUAL Y OPTICA DR. ROMAN ROMAN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DYMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-399-3755
Mailing Address - Street 1:PO BOX 6017
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-6017
Mailing Address - Country:US
Mailing Address - Phone:787-639-9834
Mailing Address - Fax:787-395-7926
Practice Address - Street 1:CARR 653 KM 2.0 SECT BARRANCA BO. HATO ABAJO
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-0061
Practice Address - Country:US
Practice Address - Phone:787-896-7041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty