Healthcare Provider Details

I. General information

NPI: 1538098454
Provider Name (Legal Business Name): OMAR DIAZ ARENCIBIA OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E 25TH ST STE 414
HIALEAH FL
33013-3835
US

IV. Provider business mailing address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

V. Phone/Fax

Practice location:
  • Phone: 305-835-7588
  • Fax:
Mailing address:
  • Phone: 954-262-1113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC6933
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: