Healthcare Provider Details

I. General information

NPI: 1326344870
Provider Name (Legal Business Name): RAPHAEL E PEREZ MD OD MBA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2011
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11466 S.W. QUAIL ROOST DRIVE
MIAMI FL
33157
US

IV. Provider business mailing address

524 FERNWOOD ROAD
MIAMI FL
33149-1842
US

V. Phone/Fax

Practice location:
  • Phone: 305-255-8559
  • Fax: 305-255-7880
Mailing address:
  • Phone: 305-255-8559
  • Fax: 305-255-7880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. RAPHAEL E. PEREZ
Title or Position: PRESIDENT
Credential: M.D., O.D, MBA
Phone: 786-853-1079