MEDICARE: ESPAILLAT OPTICAL NETWORK, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	ME81887	FL

General Provider Information

NPI Number	:	1003181785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESPAILLAT OPTICAL NETWORK, PLLC

Provider Business Mailing Address
First Line	:	681 BRICKELL KEY DR
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-2622
Country	:	US
Telephone Number	:	305-545-9393
Fax Number	:

Provider Business Practice Location Address
First Line	:	681 BRICKELL KEY DR
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-2622
Country	:	US
Telephone Number	:	305-545-9393
Fax Number	:	305-547-2393

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALEJANDRO ESPAILLAT
Credential	:	M.D.
Telephone Number	:	305-545-9393

Provider Enumeration Date	:	03/14/2012
Last Update Date	:	03/14/2012

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