Healthcare Provider Details

I. General information

NPI: 1487764403
Provider Name (Legal Business Name): MERCY OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 W 76TH ST
HIALEAH FL
33016-1834
US

IV. Provider business mailing address

2095 W 76TH ST
HIALEAH FL
33016-1834
US

V. Phone/Fax

Practice location:
  • Phone: 305-698-3030
  • Fax: 305-698-3030
Mailing address:
  • Phone: 305-698-3030
  • Fax: 305-698-3030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOE 968
License Number StateFL

VIII. Authorized Official

Name: MRS. MERCEDES PADRON
Title or Position: PRESIDENT
Credential:
Phone: 305-698-3030