Healthcare Provider Details

I. General information

NPI: 1639547201
Provider Name (Legal Business Name): KERI M POMELLA, OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2015
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 W 84TH ST
HIALEAH FL
33014-3377
US

IV. Provider business mailing address

1550 W 84TH ST STE 15
HIALEAH FL
33014-3368
US

V. Phone/Fax

Practice location:
  • Phone: 786-558-9043
  • Fax: 786-762-2926
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC3040
License Number StateFL

VIII. Authorized Official

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