Provider Demographics
NPI:1548352024
Name:FAMILY VISION CENTER INC
Entity type:Organization
Organization Name:FAMILY VISION CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:J
Authorized Official - Last Name:CORDERO-VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-844-6000
Mailing Address - Street 1:83 UNION STREET
Mailing Address - Street 2:SUITE 129
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-3686
Mailing Address - Country:US
Mailing Address - Phone:787-844-6000
Mailing Address - Fax:787-813-0843
Practice Address - Street 1:83 UNION
Practice Address - Street 2:SUITE 129
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3686
Practice Address - Country:US
Practice Address - Phone:787-844-6000
Practice Address - Fax:787-813-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherMCS MEDICAL CARD SYSTEM P
890483OtherMMM MEDICARE Y MUCHO MAC
051917OtherLA CRUZ AZUL