Provider Demographics
NPI:1245377332
Name:PROFESSIONAL OPTICAL CENTER
Entity type:Organization
Organization Name:PROFESSIONAL OPTICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAHI
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-860-0620
Mailing Address - Street 1:AVE. PRINCIPAL I-18
Mailing Address - Street 2:URB. BARALT
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-860-0620
Mailing Address - Fax:787-860-0620
Practice Address - Street 1:AVE. PRINCIPAL I-18
Practice Address - Street 2:URB. BARALT
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-860-0620
Practice Address - Fax:787-860-0620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7380063OtherHUMANA HEALTH CARE
PR215122OtherPREFERRED HEALTH
PR5350OtherAMERICAN HEALTH
PR54279OtherDAVID VISION
PRES57793OtherUIA
PR052207OtherCRUZ AZUL DE PR
PR101146OtherFIRST MEDICAL
PR992047OtherPREFERRED MEDICAL CHOICE
PR00138OtherVISION HEMISFERICA
PR=========OtherOPTICAL HEALTH CARE
PRES57793OtherUIA
PR54279OtherDAVID VISION
PR7380063OtherHUMANA HEALTH CARE