Provider Demographics
NPI:1720345176
Name:GARCIA, ROBERTO (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:GARCIA
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:HC 2 BOX 30806
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-9440
Mailing Address - Country:US
Mailing Address - Phone:787-361-2529
Mailing Address - Fax:
Practice Address - Street 1:HC 2 BOX 30806
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-9440
Practice Address - Country:US
Practice Address - Phone:787-361-2529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR804156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician