1871219105 NPI number — FAMILY VISION CENTER PONCE MALL

Table of content: (NPI 1871219105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871219105 NPI number — FAMILY VISION CENTER PONCE MALL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY VISION CENTER PONCE MALL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871219105
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
GALERIAS PONCENAS MALL
Provider Second Line Business Mailing Address:
CALLE UNION 83 SUITE 129
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-844-6000
Provider Business Mailing Address Fax Number:
787-813-0843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SUITE116
Provider Second Line Business Practice Location Address:
4990 CALLE CANDIDO HOYOS
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-844-0903
Provider Business Practice Location Address Fax Number:
787-813-0804
Provider Enumeration Date:
10/18/2022

Additional Information

Authorized Official

Authorized Official Last Name:
DE LA HOZ
Authorized Official First Name:
HEILEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-643-9250

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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