Healthcare Provider Details

I. General information

NPI: 1386573541
Provider Name (Legal Business Name): MARISOL BENAVIDES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 US HIGHWAY 27 N
AVON PARK FL
33825-2504
US

IV. Provider business mailing address

3020 S CEDAR ST
ZOLFO SPRINGS FL
33890-9618
US

V. Phone/Fax

Practice location:
  • Phone: 863-453-4177
  • Fax:
Mailing address:
  • Phone: 863-832-4202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number7818
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: