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General NPI Number Information
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NPI Number | 1265614580
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Entity Type | Organization
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Legal Business Name | FAMILY EYECARE
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | URB EL CEREZAL 1700 PARANA AVENUE
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-767-2133
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 70250 PMB 285
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City | SAN JUAN
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State | PR
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Zip | 00936-8250
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Country | US
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Telephone | 787-767-2133
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLENE CORDERO
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Credential | OD
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Telephone | 787-767-2133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0269
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License Number State | PR
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