Healthcare Provider Details

I. General information

NPI: 1174405302
Provider Name (Legal Business Name): FVC ECB OPTOMETRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 CALLE UN STE 129
PONCE PR
00730-3686
US

IV. Provider business mailing address

83 CALLE UN STE 129
PONCE PR
00730-3686
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: FVC ECB OPTOMETRIC SERVICES LLC
Title or Position: EMPLOYER
Credential:
Phone: 787-844-6000