Healthcare Provider Details

I. General information

NPI: 1750285904
Provider Name (Legal Business Name): GOLDENBLUEVISION.LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 W 39TH PL STE 1003
HIALEAH FL
33012-7036
US

IV. Provider business mailing address

1750 W 39TH PL STE 1003
HIALEAH FL
33012-7036
US

V. Phone/Fax

Practice location:
  • Phone: 305-490-3816
  • Fax:
Mailing address:
  • Phone: 305-490-3816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL

VIII. Authorized Official

Name: CARMEN RODRIGUEZ
Title or Position: MANAGER
Credential:
Phone: 954-864-5276