Provider Demographics
NPI:1528114188
Name:ROLDAN, JORGE L (OD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:L
Last Name:ROLDAN
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:75 PLAZA OCHO
Mailing Address - Street 2:URB GAN VISTA II
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-5057
Mailing Address - Country:US
Mailing Address - Phone:787-435-2932
Mailing Address - Fax:787-731-5642
Practice Address - Street 1:200 AVE FRAGOSO SUITE 108
Practice Address - Street 2:PLAZA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-3130
Practice Address - Country:US
Practice Address - Phone:787-286-0654
Practice Address - Fax:787-286-0654
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2023-11-08
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Provider Licenses
StateLicense IDTaxonomies
PR212152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist