Healthcare Provider Details

I. General information

NPI: 1215785811
Provider Name (Legal Business Name): 2010 OPTICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 NW 87TH AVE SUITE 100
DORAL FL
33178
US

IV. Provider business mailing address

5645 NW 87TH AVE SUITE 100
DORAL FL
33178
US

V. Phone/Fax

Practice location:
  • Phone: 305-362-4020
  • Fax: 305-362-2592
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL SALAS
Title or Position: PRESIDENT
Credential:
Phone: 305-362-4020