Provider Demographics
NPI:1942795331
Name:F M EYE CENTER CORP
Entity Type:Organization
Organization Name:F M EYE CENTER CORP
Other - Org Name:EYE CENTER BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FABIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-360-3006
Mailing Address - Street 1:2Q6 CALLE 17
Mailing Address - Street 2:MIRADOR BAIROA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-1006
Mailing Address - Country:US
Mailing Address - Phone:787-866-2196
Mailing Address - Fax:787-731-5642
Practice Address - Street 1:PLAZA GUAYAMA LOCAL 2B PRIMER NIVEL
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-866-2196
Practice Address - Fax:787-866-2196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-27
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR343156FX1800X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty