Healthcare Provider Details

I. General information

NPI: 1841916178
Provider Name (Legal Business Name): FAMILY VISION CENTER JUANA DIAZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA JUANA DIAZ CARR 149 LOCAL 6
JUANA DIAZ PR
00795
US

IV. Provider business mailing address

GALERIAS PONCENAS MALL CALLE UNION 83 SUITE 129
PONCE PR
00730
US

V. Phone/Fax

Practice location:
  • Phone: 787-260-2588
  • Fax: 787-813-0843
Mailing address:
  • Phone: 787-844-6000
  • Fax: 787-813-0843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEILEN M DE LA HOZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-643-9250