Healthcare Provider Details

I. General information

NPI: 1497015630
Provider Name (Legal Business Name): FLORIDA OPTOMETRIC PHYSICIANS NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7352 NW 34TH ST
MIAMI FL
33122-1266
US

IV. Provider business mailing address

7352 NW 34TH ST
MIAMI FL
33122-1266
US

V. Phone/Fax

Practice location:
  • Phone: 305-418-2025
  • Fax:
Mailing address:
  • Phone: 305-418-2025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: CALEB ROJAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-418-2025