MEDICARE: SANTA MARIA OPTICAL

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	332H00000X	Eyewear Supplier		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104205376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA MARIA OPTICAL

Provider Business Mailing Address
First Line	:	7367 SW 8TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-4539
Country	:	US
Telephone Number	:	305-265-7778
Fax Number	:	305-265-7778

Provider Business Practice Location Address
First Line	:	7367 SW 8TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-4539
Country	:	US
Telephone Number	:	305-265-7778
Fax Number	:	305-265-7778

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LOURDES ARENCIBIA
Credential	:
Telephone Number	:	786-504-1505

Provider Enumeration Date	:	05/21/2015
Last Update Date	:	05/21/2015

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Directions to “SANTA MARIA OPTICAL ” Practice Location

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