Provider Demographics
NPI:1992862015
Name:VALLES, FABIAN (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:FABIAN
Middle Name:
Last Name:VALLES
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:787-703-4411
Mailing Address - Fax:787-703-4411
Practice Address - Street 1:AVENIDA COMERIO CC33
Practice Address - Street 2:RIO HONDO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-269-7300
Practice Address - Fax:787-269-7300
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR343156FX1800X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician