Healthcare Provider Details

I. General information

NPI: 1831496462
Provider Name (Legal Business Name): JOSEFINA OPTICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5372 W 16TH AVE
HIALEAH FL
33012-2165
US

IV. Provider business mailing address

5372 W 16TH AVE
HIALEAH FL
33012-2165
US

V. Phone/Fax

Practice location:
  • Phone: 786-478-3554
  • Fax:
Mailing address:
  • Phone: 786-478-3554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0P1330
License Number StateFL

VIII. Authorized Official

Name: JUANA JOSEFINA MUNIZ
Title or Position: PRESIDENT
Credential: O.D.
Phone: 305-884-3346