Provider Demographics
NPI:1811279102
Name:FAMILY OPTICAL CENTER INC.
Entity type:Organization
Organization Name:FAMILY OPTICAL CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:787-856-8388
Mailing Address - Street 1:LOCAL # 14
Mailing Address - Street 2:YAUCO PLAZA # 1
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-4448
Mailing Address - Country:US
Mailing Address - Phone:787-856-8388
Mailing Address - Fax:
Practice Address - Street 1:LOCAL # 14
Practice Address - Street 2:YAUCO PLAZA # 1
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-4448
Practice Address - Country:US
Practice Address - Phone:787-856-8388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR299261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center