Healthcare Provider Details

I. General information

NPI: 1760976369
Provider Name (Legal Business Name): MICHAEL ERNEST MOLINO OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 WEST AVE # CU-101
MIAMI BEACH FL
33139-0900
US

IV. Provider business mailing address

2001 BISCAYNE BLVD APT 2312
MIAMI FL
33137-5018
US

V. Phone/Fax

Practice location:
  • Phone: 305-877-2026
  • Fax:
Mailing address:
  • Phone: 786-812-5781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC5551
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: