Provider Demographics
NPI:1316042724
Name:ROCA, KORAK (OD)
Entity type:Individual
Prefix:
First Name:KORAK
Middle Name:
Last Name:ROCA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 03 BOX 16936
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-9523
Mailing Address - Country:US
Mailing Address - Phone:787-448-6267
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 CARR 130 LOCAL 5 INT
Practice Address - Street 2:LA CEIBA VILLAGE SHOPPING CENTER
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-1802
Practice Address - Country:US
Practice Address - Phone:787-820-3322
Practice Address - Fax:787-731-5642
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR592152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist