Healthcare Provider Details

I. General information

NPI: 1427704410
Provider Name (Legal Business Name): SOUTH FLORIDA VISION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6504 NW 186TH ST
HIALEAH FL
33015-6004
US

IV. Provider business mailing address

2900 W CYPRESS CREEK RD STE 4
FT LAUDERDALE FL
33309-1715
US

V. Phone/Fax

Practice location:
  • Phone: 305-820-2033
  • Fax:
Mailing address:
  • Phone: 954-676-8446
  • Fax: 954-979-2175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT C. COPPOLA
Title or Position: PRESIDENT
Credential: OD
Phone: 954-676-8446