Healthcare Provider Details

I. General information

NPI: 1588592547
Provider Name (Legal Business Name): ELISABETH YERA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 W 76TH ST APT 201
HIALEAH FL
33016-5678
US

IV. Provider business mailing address

2505 W 76TH ST APT 201
HIALEAH FL
33016-5678
US

V. Phone/Fax

Practice location:
  • Phone: 786-468-4816
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6940
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: