Healthcare Provider Details

I. General information

NPI: 1235985268
Provider Name (Legal Business Name): KERI M POMELLA OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E 4TH AVE
HIALEAH FL
33010-4103
US

IV. Provider business mailing address

1001 E 4TH AVE
HIALEAH FL
33010-4103
US

V. Phone/Fax

Practice location:
  • Phone: 785-953-5480
  • Fax: 786-762-2926
Mailing address:
  • Phone: 786-953-5480
  • Fax: 786-762-2926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: KERI MARIE POMELLA
Title or Position: OPTOMETRIST
Credential: OD
Phone: 786-558-9043