Healthcare Provider Details

I. General information

NPI: 1740889385
Provider Name (Legal Business Name): MARK ALEXANDER CIMINI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2020
Last Update Date: 10/25/2020
Certification Date: 10/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1097 S LE JEUNE RD
CORAL GABLES FL
33134-2639
US

IV. Provider business mailing address

185 SW 7TH ST APT 2805
MIAMI FL
33130-2978
US

V. Phone/Fax

Practice location:
  • Phone: 305-442-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC5844
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: