MEDICARE: MRS. IDALYS ROSA TORRES

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	DO3061	FL

General Provider Information

NPI Number	:	1740382977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IDALYS ROSA TORRES

Provider Business Mailing Address
First Line	:	3413 NW 17TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-5537
Country	:	US
Telephone Number	:	305-635-1614
Fax Number	:	305-635-7476

Provider Business Practice Location Address
First Line	:	3413 NW 17TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-5537
Country	:	US
Telephone Number	:	305-635-1614
Fax Number	:	305-635-7476

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	07/08/2007

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