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General NPI Number Information
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NPI Number | 1114072600
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Entity Type | Organization
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Legal Business Name | FIRST OPTICAL CENTER
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | CENTRO COMERCIAL LOS DOMINICOS 19
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-795-5109
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Fax | 787-795-5109
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Provider Business Mailing Address
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Address Line | PO BOX 3012
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City | GUAYNABO
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State | PR
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Zip | 00970-3012
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Country | US
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Telephone | 787-795-5109
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Fax | 787-795-5109
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Authorized Official
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Title or Position | MANAGER
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Name | RAQUEL ROBLES
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Credential |
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Telephone | 787-795-5109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 186
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License Number State | PR
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