MEDICARE: MRS. MIRIAM S CUENCA OPTICIAN

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	156FX1800X	Optician	DO2435	FL

General Provider Information

NPI Number	:	1255463998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MIRIAM S CUENCA OPTICIAN

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	:

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	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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