OPTOMETRY IN SPAIN: AN UNSTOPPABLE EVOLUTION. GENERAL COUNCIL OF OPTOMETRY of SPAIN Jesús García Poyatos, D.O.O., M.Sc. International Affairs Advisor

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1 OPTOMETRY IN SPAIN: AN UNSTOPPABLE EVOLUTION GENERAL COUNCIL OF OPTOMETRY of SPAIN Jesús García Poyatos, D.O.O., M.Sc. International Affairs Advisor

2 Summary NATIONAL COLLEGE OF OPTICIANS- OPTOMETRISTS OF SPAIN OPTICIAN-OPTOMETRIST PROFESSION OPTOMETRY IN SPAIN: A UNIVERSITY DEGREE Optics-Optometry in Spain: The role of the Optician- Optometrist THE SPANISH OPTOMETRIST IN PRIMARY CARE THE LATEST POLITICAL AND LEGISLATIVE ADVANCES IN SPANISH OPTOMETRY 2

3 Summary NATIONAL COLLEGE OF OPTICIANS- OPTOMETRISTS OF SPAIN OPTICIAN-OPTOMETRIST PROFESSION OPTOMETRY IN SPAIN: A UNIVERSITY DEGREE Optics-Optometry in Spain: The role of the Optician- Optometrist THE SPANISH OPTOMETRIST IN PRIMARY CARE THE LATEST POLITICAL AND LEGISLATIVE ADVANCES IN SPANISH OPTOMETRY 3

4 NATIONAL COLLEGE OF OPTICIANS-OPTOMETRISTS OPTOMETRISTS OF SPAIN The National College of Optics, was created by Royal Decree on 1964 Statutes were approved by agreement of the Labor-Union Organization on Regional Offices were brought together and recognized. 4

5 NATIONAL COLLEGE OF OPTICIANS-OPTOMETRISTS OPTOMETRISTS OF SPAIN New Law about Professional Colleges on 1974 On 1977 is complemented regarding the National College of Optics Our relationship with the Administration shall be done through Government Department of Public Health. 5

6 NATIONAL COLLEGE OF OPTICIANS-OPTOMETRISTS OPTOMETRISTS OF SPAIN The new Statutes of the National College of Optics are approved on Regulations of Internal Rules appear structured. 6

7 NATIONAL COLLEGE OF OPTICIANS-OPTOMETRISTS OPTOMETRISTS OF SPAIN University Degree in Optic and Optometry is established on New members of the College shall be qualified opticians-optometrists. The National College of Optics becomes the National College of Opticians-Optometrists on

8 Summary NATIONAL COLLEGE OF OPTICIANS- OPTOMETRISTS OF SPAIN OPTICIAN-OPTOMETRIST PROFESSION OPTOMETRY IN SPAIN: A UNIVERSITY DEGREE Optics-Optometry in Spain: The role of the Optician- Optometrist THE SPANISH OPTOMETRIST IN PRIMARY CARE THE LATEST POLITICAL AND LEGISLATIVE ADVANCES IN SPANISH OPTOMETRY 8

9 OPTICIAN-OPTOMETRIST OPTOMETRIST PROFESSION Optic profession in Spain is being performed from time immemorial Daza de Valdés wrote the work Use of glasses for all kind of eyesight on books dedicated to the nature and properties of the eye and the remedies for eyesight by the use of glasses. 9

10 OPTICIAN-OPTOMETRIST OPTOMETRIST PROFESSION The first Spanish Optics Association is created on 1918 with its Statutes. The profession is, beside a commercial activity, a scientific profession serving the eyesight health. 10

11 OPTICIAN-OPTOMETRIST OPTOMETRIST PROFESSION First issue or the professional magazine, Spanish Magazine of Optics on Need of an Official Professional College. Defend the commercial, professional and scientific interests. Legislation which regulated the practice of the profession. 11

12 OPTICIAN-OPTOMETRIST OPTOMETRIST PROFESSION Trained in the daily practice, courses, seminars, conferences, and reading publications. Until 1956 when the Degree in Binocular Optics is created. 12

13 OPTICIAN-OPTOMETRIST OPTOMETRIST PROFESSION The Degree demanded several practical knowledge useful, not only for being a glasses dealer, but for the practice of Optometry. 13

14 OPTICIAN-OPTOMETRIST OPTOMETRIST PROFESSION The Daza de Valdés Institute starting organizing courses on 1956 for obtaining the Degree in Binocular Optics. 14

15 OPTICIAN-OPTOMETRIST OPTOMETRIST PROFESSION 1961 regulation of the profession of optics. demanding a holder of diploma in optics for all establishments of Opticians 15

16 OPTICIAN-OPTOMETRIST OPTOMETRIST PROFESSION Creation of the National College of Optics on 1964 structuring the professional community looking alter the quality of professional tasks fighting against the illegal practice of the profession 16

17 OPTICIAN-OPTOMETRIST OPTOMETRIST PROFESSION 1972 was created the School of Optics at the Complutense University of Madrid. After three courses of higher education diploma in optics 17

18 OPTICIAN-OPTOMETRIST OPTOMETRIST PROFESSION official university degree in Optic and Optometry Diploma. 18

19 Summary NATIONAL COLLEGE OF OPTICIANS- OPTOMETRISTS OF SPAIN OPTICIAN-OPTOMETRIST PROFESSION OPTOMETRY IN SPAIN: A UNIVERSITY DEGREE Optics-Optometry in Spain: The role of the Optician- Optometrist THE SPANISH OPTOMETRIST IN PRIMARY CARE THE LATEST POLITICAL AND LEGISLATIVE ADVANCES IN SPANISH OPTOMETRY 19

20 OPTOMETRY IN SPAIN: A UNIVERSITY DEGREE First University College of Optics and Optometry created in Nowadays, 11 University Colleges: 9 Public Universities 2 Private Universities 20

21 21

22 OPTOMETRY IN SPAIN: A UNIVERSITY DEGREE More than 4000 students. Same basic core subjects. Complemented with compulsory and optional subjects. Offering basic and a professional training: Highly qualified opticians-optometrists. Contributing to eye healthcare. 22

23 OPTOMETRY IN SPAIN: A UNIVERSITY DEGREE Qualify them for: Optometric examinations. Lens prescriptions. Preserve and improve sight. Visual training. Cut, make up, adjust and supply any optical systems. Refer patients to appropriate specialist. 23

24 OPTOMETRY IN SPAIN: A UNIVERSITY DEGREE Great demand for this university degree. Important role in country s health, technological and economical development. Future graduates are becoming more flexible and adaptable. 24

25 OPTOMETRY IN SPAIN: A UNIVERSITY DEGREE European Association of Optometry Schools and Colleges (AEUSCO) was created in The University of Madrid chair AEUSCO from the start. 25

26 Optics-Optometry Optometry in Spain: The role of the Optician-Optometrist Optometrist Independent primary healthcare profession. Clinical application of ocular physiology. Prevention and correction of disorders of the visual system by: examination. diagnosis and treatment of visual anomalies. discovery of any systemic and pathological signs. 26

27 Optics-Optometry Optometry in Spain: The role of the Optician-Optometrist Optometrist Optometry in Spain covers: refractive error measuring visual development and learning binocular dysfunction visual ergonomics referral to a specialist adapt and supply aids to compensate, treat or relieve visual defects 27

28 Optics-Optometry Optometry in Spain: The role of the Optician-Optometrist Optometrist Optometry only practiced by a university qualified professional in optics and optometry: Official valid degree in optics and optometry Registered in the National College of Opticians-Optometrists of Spain 28

29 Optics-Optometry Optometry in Spain: The role of the Optician-Optometrist Optometrist Primary healthcare professional who specialises in poorly functioning visual systems. Trained professionals in: normal and abnormal eye physiology vision psychophysics perception processes 29

30 Optics-Optometry Optometry in Spain: The role of the Optician-Optometrist Optometrist Trained and legally authorized to: Determine the health condition and functional assessment of the components of the visual system. 30

31 Optics-Optometry Optometry in Spain: The role of the Optician-Optometrist Optometrist Trained and legally authorized to: Examine, treat and prescribe preventive and corrective devices to compensate visual anomalies. 31

32 Optics-Optometry Optometry in Spain: The role of the Optician-Optometrist Optometrist Trained and legally authorized to: Detect ocular and systemic pathologies. Refer patients to the appropriate healthcare professional. 32

33 Optics-Optometry Optometry in Spain: The role of the Optician-Optometrist Optometrist Also can specialize in: contactology paediatrics geriatrics low vision ergonomics - vision at the workplace sports vision visual training / re-education neuro-optometry and optical instrumentation. 33

34 Optics-Optometry Optometry in Spain: The role of the Optician-Optometrist Optometrist Importance of Optics-Optometry in primary visual healthcare. The first contact in the detection of unsuspected systemic disorders. 34

35 Optics-Optometry Optometry in Spain: The role of the Optician-Optometrist Optometrist Detection of glaucoma, cataracts, retinal haemorrhage, optic atrophy, blocked ophthalmic artery and so on. 35

36 Optics-Optometry Optometry in Spain: The role of the Optician-Optometrist Optometrist Work in public or private healthcare centres and visual rehabilitation organisations. Carry out primary healthcare, training, research, and the rehabilitation of low vision anomalies. 36

37 OPTOMETRY IN SPAIN: A UNIVERSITY DEGREE DEGREE Professional Practice 2 LEVELS POSTGRADUATE MASTERS PhD Specialization Research Teaching 37

38 OPTOMETRY IN SPAIN: A UNIVERSITY DEGREE PhD MASTERS M2 M1 M1 G4 DEGREE G3 G2 G3 G2 G1 G1 38

39 Summary NATIONAL COLLEGE OF OPTICIANS- OPTOMETRISTS OF SPAIN OPTICIAN-OPTOMETRIST PROFESSION OPTOMETRY IN SPAIN: A UNIVERSITY DEGREE Optics-Optometry in Spain: The role of the Optician- Optometrist THE SPANISH OPTOMETRIST IN PRIMARY CARE THE LATEST POLITICAL AND LEGISLATIVE ADVANCES IN SPANISH OPTOMETRY 39

40 THE SPANISH OPTOMETRIST IN PRIMARY CARE Free and universal national health system. This care is offered throughout: primary, secondary, tertiary or specialized care. Complete network of outpatients departments and hospitals throughout the country. Acceptable healthcare system problems of overcrowding and waiting lists 40

41 THE SPANISH OPTOMETRIST IN PRIMARY CARE Prescription of drugs from the National Health Service (INSALUD) is practically free. Funded by company taxing and compulsory percentage (6%) on the monthly earnings of employees. 41

42 THE SPANISH OPTOMETRIST IN PRIMARY CARE Private medical companies have made notable progress. Less crowded and more personalised system. Complement healthcare with a private insurance option. 42

43 THE SPANISH OPTOMETRIST IN PRIMARY CARE Optician-optometrist practices are defined by law as a healthcare establishment. Must meet at least the following conditions: 43

44 THE SPANISH OPTOMETRIST IN PRIMARY CARE The permanent and ongoing presence of the Optician-Optometrist. Minimum set of instruments and protocols on proceedings. License, prior membership of the National College of Opticians-Optometrists of Spain. Inspection by the regional health authorities. 44

45 THE SPANISH OPTOMETRIST IN PRIMARY CARE 63% of the Spanish population go to the optician-optometrist. 37% visit an ophthalmologist: 26% under the National Health Service 11% attend private ophthalmologists or those of private health insurance. 45

46 THE SPANISH OPTOMETRIST IN PRIMARY CARE Increased life expectancy Improved quality of life Surgical and pharmacological advances Saturated national health ophthalmology services. Causes alarm and social dissatisfaction. 46

47 THE SPANISH OPTOMETRIST IN PRIMARY CARE INSALUD has approached the National College of Opticians-Optometrists of Spain. Optometrist s help in reducing waiting lists Relieve ophthalmologist of everything to do with primary visual care 47

48 THE SPANISH OPTOMETRIST IN PRIMARY CARE Significant agreements for collaboration has been reached. In five autonomous Spanish regions: Community of Andalusia Basque Country Community of Aragon Community of the Canary Islands Community of Madrid 48

49 THE SPANISH OPTOMETRIST IN PRIMARY CARE Collaboration agreements have been set up: Regional health authority of the Andalusian Health Service Basque Health Service Department of Health, Consumption and Social Services of the Aragon General Deputation Canary Island Health Service Health Council of the Autonomous Community of Madrid 49

50 50

51 THE SPANISH OPTOMETRIST IN Objectives: PRIMARY CARE To establish the mechanisms for the prevention of visual problems, the correction and promotion of vision, aimed at patients, referred by the different health services of the various autonomous regions, via family doctors or general practitioners. 51

52 THE SPANISH OPTOMETRIST IN PRIMARY CARE The integration of the optician-optometrist as a primary sight carer in the national health system. The publication of common protocols. To inform and advise the public of changes in visual capacity. 52

53 THE SPANISH OPTOMETRIST IN PRIMARY CARE Allows general practitioners, when seeing a patient with visual problems with no pathology, to refer this patient to an optometrist. 53

54 THE SPANISH OPTOMETRIST IN PRIMARY CARE Optometrists must meet several requirements. Must appear on an official list. Must carry out the following clinical procedures for all cases: 54

55 THE SPANISH OPTOMETRIST IN PRIMARY CARE Assessment of the refractive condition. Assessment of the afferent and efferent neurological pathways. Assessment of the individual s flat fusion ability. To determine the integrity of the visual field of the macular region. To determine intraocular pressure value (IOP) Refraction Binocularity Ocular health 55

56 THE SPANISH OPTOMETRIST IN PRIMARY CARE Other tests to be carried out: Ophthalmoscopy Tonometry Keratometry Perimetry Confrontation visual fields Slit lamp observation Retinography, etc. 56

57 THE SPANISH OPTOMETRIST IN PRIMARY CARE If any pathological abnormality, the patient should be referred to the appropriate professional. 57

58 THE SPANISH OPTOMETRIST IN PRIMARY CARE Optician-optometrists should draw up an optometric report for the Health Services epidemiological and statistical studies. 58

59 THE SPANISH OPTOMETRIST IN PRIMARY CARE These agreements have entailed many political benefits for the National College of Opticians-Optometrists. Great opportunity to form a part of the Spanish Public Health Service. 59

60 THE SPANISH OPTOMETRIST IN Benefits PRIMARY CARE A universal service. Geographic dispersion. Agreement negotiated at corporate level. Strengthening of the profession. A challenge for the future. Experience in primary visual health care. 60

61 THE SPANISH OPTOMETRIST IN PRIMARY CARE These agreements are the first step towards the total integration of the Spanish optometrist into the National Health System in primary care. 61

62 THE SPANISH OPTOMETRIST IN PRIMARY CARE If authorities wish to offer general public quality primary visual and ocular health care at less cost, they must consider opticians-optometrists as independent suppliers of this primary care. 62

63 Summary NATIONAL COLLEGE OF OPTICIANS- OPTOMETRISTS OF SPAIN OPTICIAN-OPTOMETRIST PROFESSION OPTOMETRY IN SPAIN: A UNIVERSITY DEGREE Optics-Optometry in Spain: The role of the Optician- Optometrist THE SPANISH OPTOMETRIST IN PRIMARY CARE THE LATEST POLITICAL AND LEGISLATIVE ADVANCES IN SPANISH OPTOMETRY 63

64 THE LATEST POLITICAL AND LEGISLATIVE ADVANCES IN SPANISH OPTOMETRY A. ROYAL DECREE ON HEALTH CARE ESTABLISHMENTS B. LAW ON THE REGULATING OF HEALTHCARE PROFESSIONS C. THE SUPREME COURT RULES AGAINST OPHTHALMOLOGISTS D. THE ANDALUSIA HIGH COURT OF JUSTICE RULING 64

65 THE LATEST POLITICAL AND LEGISLATIVE ADVANCES IN SPANISH OPTOMETRY A. ROYAL DECREE ON HEALTH CARE ESTABLISHMENTS B. LAW ON THE REGULATING OF HEALTHCARE PROFESSIONS C. THE SUPREME COURT RULES AGAINST OPHTHALMOLOGISTS D. THE ANDALUSIA HIGH COURT OF JUSTICE RULING 65

66 Royal Decree On Health Care Establishments To establish the general bases for the authorisation of health centres, services and healthcare establishments. To comply with: Law 114/1986 on General Health Law 16/2003 on National Health System Cohesion and Quality 66

67 Royal Decree On Health Care Establishments To regulate the general bases of the authorisation process by the autonomous regions. To establish a common classification, denomination and definition for the creation of a general register. To establish the general catalogue and register. 67

68 Royal Decree On Health Care Establishments To be applied to all health centres, services, healthcare establishments, whether public or private of any type. Healthcare establishments understood as: 68

69 Healthcare establishment An organised group of technical instruments and installations where officially qualified professionals, carry out basic health activities, the dispensing of drugs or health products adapted to the individual. 69

70 Royal Decree On Health Care Establishments Common minimum requirements determined by royal decree. Requirements may be complemented in each autonomous region. 70

71 Royal Decree On Health Care Establishments General register in the Ministry or Health showing any decisions, communications and authorizations of the autonomous regions on health matters. 71

72 Royal Decree On Health Care Establishments Any advertising should show the register number awarded by the health authority of the autonomous region. 72

73 Royal Decree On Health Care Establishments Period of eighteen months from the date this Royal Decree comes into force to meet this regulation. 73

74 Royal Decree On Health Care Establishments Optician s are considered healthcare establishments, defined as: 74

75 Optician s Healthcare establishments where, under the technical direction of a graduate in optics and optometry, activities are undertaken involving the assessment of visual ability using optometric techniques; the cutting, making up, adjusting, supply, selling, checking and monitoring of the appropriate means for the prevention, detection, protection and improvement of visual acuity; help for low vision and the adjustment of external ocular prostheses. 75

76 Royal Decree On Health Care Establishments This Royal Decree came into force on 24 October

77 THE LATEST POLITICAL AND LEGISLATIVE ADVANCES IN SPANISH OPTOMETRY A. ROYAL DECREE ON HEALTH CARE ESTABLISHMENTS B. LAW ON THE REGULATING OF HEALTHCARE PROFESSIONS C. THE SUPREME COURT RULES AGAINST OPHTHALMOLOGISTS D. THE ANDALUSIA HIGH COURT OF JUSTICE RULING 77

78 Law On The Regulating Of Healthcare Professions To regulate: Basic aspects of qualified healthcare professions. General structure of professional training. Professional development. Their participation in the planning and regulating of healthcare professionals. 78

79 Law On The Regulating Of Healthcare Professions Establishes registers of professionals: Rights of the public with regard to the provision of healthcare. Appropriate planning of the health system s human resources. 79

80 Law On The Regulating Of Healthcare Professions Applicable in public or private healthcare services. Qualified Healthcare Professions are shown as: 80

81 Qualified and regulated healthcare professions those whose undergraduate or specialist training is specifically and essentially directed at equipping those undertaking it with the knowledge, skills and attitudes appropriate to healthcare and are organised in officially recognised professional colleges. 81

82 Law On The Regulating Of Healthcare Professions Graduates in optics and optometry are shown as healthcare professionals. At graduate level: the professions whose practice is enabled by holding the title of Graduate in... Optics and Optometry... 82

83 Healthcare graduates Healthcare graduates should, within the field of activity for which they have the appropriate title, personally deliver the care or services of their professional competence in the different phases of the healthcare process, without undermining the competence, responsibility and autonomy of the different professionals involved in this process.. 83

84 Optician-optometrists University graduates in optics and optometry carry out activities for the detection of ocular refraction defects, by their measurement using instruments, the use of re-education prevention and visual hygiene techniques and the adjustment, verification and monitoring of optical aids. 84

85 Continuing education The active and permanent process of education and learning to which healthcare professionals are entitled and obliged to undertake. 85

86 Continuing education This starts at the end of the period of undergraduate or specialist study and is aimed at updating and improving the knowledge, skills and attitudes of healthcare professionals with regard to the scientific and technological evolution in demand from and the needs of society and of the health system itself. 86

87 Law On The Regulating Of Healthcare Professions Protocols must be written for any healthcare action. An Continuing education Committee has been created which will include representatives from the professional colleges. 87

88 Law On The Regulating Of Healthcare Professions Establish procedures for the examination of their professional development and career. Supervised, in their implementation and development, by the appropriate health authority. 88

89 Law On The Regulating Of Healthcare Professions Advertising of services must rigorously respect the scientific basis of activities and prescriptions. Objective, careful and true, so as not to raise false hopes. 89

90 Law On The Regulating Of Healthcare Professions Information given must be true, discreet, careful and shown in a comprehensible manner. Failure to comply shall result in sanctions. 90

91 Law On The Regulating Of Healthcare Professions Demands guarantees of safety and quality in private professional practice. Obtain help from quality agencies or the professional colleges. 91

92 Law On The Regulating Of Healthcare Professions Obligation to take out the appropriate liability insurance. Professional colleges may adopt the necessary means to enable their members to fulfil this obligation. 92

93 Law On The Regulating Of Healthcare Professions Public registers of healthcare professionals in order to ensure that patients may exercise their rights with regard to clinical information and documentation. 93

94 Law On The Regulating Of Healthcare Professions Registers must be public and accessible to the public. Must be at the disposal of the health authorities. Show the name, title, speciality and place where the professional practices. 94

95 THE LATEST POLITICAL AND LEGISLATIVE ADVANCES IN SPANISH OPTOMETRY A. ROYAL DECREE ON HEALTH CARE ESTABLISHMENTS B. LAW ON THE REGULATING OF HEALTHCARE PROFESSIONS C. THE SUPREME COURT RULES AGAINST OPHTHALMOLOGISTS D. THE ANDALUSIA HIGH COURT OF JUSTICE RULING 95

96 The Supreme Court Rules Against Ophthalmologists OPTICIANS-OPTOMETRISTS DO NOT INVADE THE COMPETENCES OF OPHTHALMOLOGISTS RULING REJECTS AN APPEAL LAUNCHED BY THE COLLEGE OF PHYSICIANS 96

97 The Supreme Court Rules Against Ophthalmologists The Official College of Physicians of the Balearic Islands: There is a clear invasion of the professional competences of ophthalmologist physicians, namely the determining of the visual capacity of the human being and the prescription of corrective ocular prostheses which are not the legal competence of opticiansoptometrists. 97

98 The Supreme Court Rules Against Ophthalmologists The sentence passed by the High Court of Justice of the Balearic Islands was completely overruled. The College of Physicians launched an appeal. The Supreme Court overruled this. 98

99 The Supreme Court Rules Against Ophthalmologists Opticians-optometrists are university graduates in optics and optometry who carry out activities to detect ocular refraction defects, by their measurement using instruments, the use of re-education prevention and visual hygiene techniques and the adjustment, verification and monitoring of optical aids. 99

100 The Supreme Court Rules Against Ophthalmologists There was and is no reserve for the medical profession as alleged by the appellant with regard to the detection of ocular refraction detection, on the adjustment, checking and monitoring of visual aids. 100

101 The Supreme Court Rules Against Ophthalmologists It does not appear that public health is put at risk by the recognition of university graduates in optics and optometry, bearing in mind their academic training, for their professional function. 101

102 The Supreme Court Rules Against Ophthalmologists The profession of the opticianoptometrist was created, a university degree being required for its practice involving academic training and sufficient knowledge, precisely for determining the condition of sight 102

103 The Supreme Court Rules Against Ophthalmologists This does not affect the specific competences of ophthalmologists with regard to eye and vision pathology. 103

104 THE LATEST POLITICAL AND LEGISLATIVE ADVANCES IN SPANISH OPTOMETRY A. ROYAL DECREE ON HEALTH CARE ESTABLISHMENTS B. LAW ON THE REGULATING OF HEALTHCARE PROFESSIONS C. THE SUPREME COURT RULES AGAINST OPHTHALMOLOGISTS D. THE ANDALUSIA HIGH COURT OF JUSTICE RULING 104

105 The Andalusia High Court of Justice The Andalusia High Court of Justice rejected the Medical Association s appeal against the agreement signed. Development of sight prevention and promotion activities does not invade the area of competence of the ophthalmologist. 105

106 The Andalusia High Court of Justice Does not constitute unfair competition to the ophthalmologist. an instrument for the Andalusian public health authority to improve health care by means of rapid client service. 106

107 The Andalusia High Court of Justice When a patient visits their G.P. with a sight problem, the doctor can refer them to any optician-optometrists to have their sight tested. 107

108 The Andalusia High Court of Justice Assessing patients eyesight is one of the functions of an opticianoptometrists, and, therefore, work on information to improve sight, sight promotion, prevention and hygiene do not constitute any invasion of the area of activity of ophthalmologists 108

109 Thank you for your kind invitation! Jesús García Poyatos, D.O.O., M.Sc. International Affairs Advisor Colegio Nacional de Ópticos - Optometristas Princesa, 25, 4ª planta Edificio Hexágono Madrid (Spain) / 4 Phone Fax Cell phone jgarcia@cnoo.es

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