Healthcare Provider Details

I. General information

NPI: 1053473132
Provider Name (Legal Business Name): POOLE AND VILLANI, M.D.,'S, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 KANE CONCOURSE STE 607
BAY HARBOR ISLANDS FL
33154-2044
US

IV. Provider business mailing address

1111 KANE CONCOURSE STE 607
BAY HARBOR ISLANDS FL
33154-2044
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2047
  • Fax: 305-674-2939
Mailing address:
  • Phone: 305-674-2047
  • Fax: 305-674-2939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: LUIS DIEGO VILLANI
Title or Position: PRESIDENT
Credential: MD
Phone: 305-674-2047