Healthcare Provider Details

I. General information

NPI: 1386875896
Provider Name (Legal Business Name): MARIO CARCAMO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7795 W FLAGLER ST #63
MIAMI FL
33144-2368
US

IV. Provider business mailing address

7795 W FLAGLER ST #63
MIAMI FL
33144-2359
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-2990
  • Fax: 305-380-7106
Mailing address:
  • Phone: 305-662-2990
  • Fax: 305-380-7106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MARIO IVAN CARCAMO
Title or Position: MANAGER OWNER
Credential: O.D.
Phone: 305-662-2990