Healthcare Provider Details

I. General information

NPI: 1649300724
Provider Name (Legal Business Name): LENWARD MCCALLA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11417 S DIXIE HWY
MIAMI FL
33156-4443
US

IV. Provider business mailing address

15141 SW 159TH ST
MIAMI FL
33187-6601
US

V. Phone/Fax

Practice location:
  • Phone: 305-378-1915
  • Fax: 305-256-6919
Mailing address:
  • Phone: 305-378-1915
  • Fax: 305-256-6919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2077
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: