Healthcare Provider Details

I. General information

NPI: 1114479714
Provider Name (Legal Business Name): FABILENS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2016
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 NW 104TH AVE UNIT C103
DORAL FL
33178-3360
US

IV. Provider business mailing address

7450 NW 104TH AVE UNIT C103
DORAL FL
33178-3360
US

V. Phone/Fax

Practice location:
  • Phone: 786-228-7932
  • Fax:
Mailing address:
  • Phone: 786-228-7932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC3384
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDO6821
License Number StateFL

VIII. Authorized Official

Name: MR. FRANCO ENCINA
Title or Position: OWNER
Credential:
Phone: 786-228-7932