Provider Demographics
NPI:1841231180
Name:FAMILY OPTICAL CENTER INC.
Entity Type:Organization
Organization Name:FAMILY OPTICAL CENTER INC.
Other - Org Name:FAMILY VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SANTA
Authorized Official - Middle Name:ROMAN
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:787-892-3450
Mailing Address - Street 1:PLAZA DEL OESTE SHOPPING CENTER
Mailing Address - Street 2:AVE. CASTO PEREZ # 321
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683
Mailing Address - Country:US
Mailing Address - Phone:787-892-3450
Mailing Address - Fax:787-892-3430
Practice Address - Street 1:321 AVE CASTO PEREZ
Practice Address - Street 2:
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:787-892-3430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR299261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR101266OtherI VISION
PR215270OtherPREFERRED HEALT PLAN
PR56672OtherTRIPLE-S
PR00133OtherVISION HEMISFERICA
PR052233OtherCRUZ AZUL
PR890153OtherMMM