Provider Demographics
NPI:1407880800
Name:ROMAN, RUBEN (OD)
Entity type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:
Last Name:ROMAN
Suffix:
Gender:
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:PO BOX 367310
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-7310
Mailing Address - Country:US
Mailing Address - Phone:787-283-1586
Mailing Address - Fax:
Practice Address - Street 1:D16 CALLE AA
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-3151
Practice Address - Country:US
Practice Address - Phone:787-283-6567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR431152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist