Provider Demographics
NPI:1316042724
Name:ROCA, KORAK (OD)
Entity Type:Individual
Prefix:
First Name:KORAK
Middle Name:
Last Name:ROCA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC-03 BOX 16936
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678
Mailing Address - Country:US
Mailing Address - Phone:787-243-4679
Mailing Address - Fax:
Practice Address - Street 1:412 AVE. TRIO VEGABAJENO
Practice Address - Street 2:LOCAL # 2
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-858-1695
Practice Address - Fax:787-858-1695
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR592152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist