MEDICARE: DR. KELVIN SANTOS ROMAN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	734	PR

General Provider Information

NPI Number	:	1114431509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELVIN SANTOS ROMAN OD

Provider Business Mailing Address
First Line	:	PO BOX 801219
Second Line	:
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-1219
Country	:	US
Telephone Number	:	787-585-0801
Fax Number	:

Provider Business Practice Location Address
First Line	:	FAMILY VISION CENTER PLAZA GUAYAMA MALL
Second Line	:	LOCAL 48
City	:	GUAYAMA
State	:	PR
Zip	:	00784
Country	:	US
Telephone Number	:	787-864-6884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2017
Last Update Date	:	05/05/2026

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