Healthcare Provider Details

I. General information

NPI: 1346919743
Provider Name (Legal Business Name): NICHOLAS BARLAS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 NW 183RD ST
MIAMI GARDENS FL
33055-2955
US

IV. Provider business mailing address

532 S LUNA CT APT 1
HOLLYWOOD FL
33021-7536
US

V. Phone/Fax

Practice location:
  • Phone: 305-621-3830
  • Fax:
Mailing address:
  • Phone: 708-200-5869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC6006
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: