MEDICARE: FAMILY EYECARE

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	0269	PR

General Provider Information

NPI Number	:	1265614580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY EYECARE

Provider Business Mailing Address
First Line	:	PO BOX 70250
Second Line	:	PMB 285
City	:	SAN JUAN
State	:	PR
Zip	:	00936-8250
Country	:	US
Telephone Number	:	787-767-2133
Fax Number	:

Provider Business Practice Location Address
First Line	:	URB EL CEREZAL
Second Line	:	1700 PARANA AVENUE
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-767-2133
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHARLENE CORDERO
Credential	:	OD
Telephone Number	:	787-767-2133

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	11/28/2007

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