Healthcare Provider Details

I. General information

NPI: 1134827199
Provider Name (Legal Business Name): BEACON EYE CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7328 NW 36TH ST UNIT 104
MIAMI FL
33166-6735
US

IV. Provider business mailing address

7328 NW 36TH ST UNIT 104
MIAMI FL
33166-6735
US

V. Phone/Fax

Practice location:
  • Phone: 305-717-9995
  • Fax: 305-717-1558
Mailing address:
  • Phone: 305-717-9995
  • Fax: 305-717-1558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code156FX1202X
TaxonomyOptometric Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSUE ROJA
Title or Position: PRESIDENT
Credential: LDO
Phone: 305-717-9995