Healthcare Provider Details

I. General information

NPI: 1801371539
Provider Name (Legal Business Name): MM EYECARE CONSULTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 W 68TH ST
HIALEAH FL
33014-4403
US

IV. Provider business mailing address

1949 W 68TH ST
HIALEAH FL
33014-4403
US

V. Phone/Fax

Practice location:
  • Phone: 786-391-1301
  • Fax: 786-391-1240
Mailing address:
  • Phone: 786-391-1303
  • Fax: 786-391-1240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. MANUEL MUNIZ
Title or Position: OWNER
Credential: OD
Phone: 786-391-1303