Healthcare Provider Details

I. General information

NPI: 1053132027
Provider Name (Legal Business Name): STYLE SITE OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 11/09/2024
Certification Date: 11/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19013 BISCAYNE BLVD
AVENTURA FL
33180-2819
US

IV. Provider business mailing address

19013 BISCAYNE BLVD
AVENTURA FL
33180-2819
US

V. Phone/Fax

Practice location:
  • Phone: 305-935-5250
  • Fax:
Mailing address:
  • Phone: 305-935-5250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. TERESITA A BOLLAR
Title or Position: OWNER
Credential: OD
Phone: 305-935-5250