Healthcare Provider Details

I. General information

NPI: 1760301287
Provider Name (Legal Business Name): KEVIN RYAN VAZQUEZ OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2517 NE 10TH CT
HOMESTEAD FL
33033-4719
US

IV. Provider business mailing address

12715 SW 112TH TER
MIAMI FL
33186-4720
US

V. Phone/Fax

Practice location:
  • Phone: 305-242-0996
  • Fax:
Mailing address:
  • Phone: 786-763-5958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7029
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: