Provider Demographics
NPI:1598756165
Name:FAMILY OPTICAL CENTER
Entity Type:Organization
Organization Name:FAMILY OPTICAL CENTER
Other - Org Name:FAMILY VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANTA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:787-892-3450
Mailing Address - Street 1:321 AVE CASTO PEREZ
Mailing Address - Street 2:PLAZA DEL OESTE SHOPPING CENTER
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-4700
Mailing Address - Country:US
Mailing Address - Phone:787-892-3450
Mailing Address - Fax:787-892-3450
Practice Address - Street 1:321 AVE CASTO PEREZ
Practice Address - Street 2:PLAZA DEL OESTE SHOPPING CENTER
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4700
Practice Address - Country:US
Practice Address - Phone:787-892-3450
Practice Address - Fax:787-892-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR299261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR052233OtherCRUZ AZUL
PR890153OtherMMM
PR215270OtherPREFERRED