Healthcare Provider Details

I. General information

NPI: 1992911929
Provider Name (Legal Business Name): MARCO POLO OPTICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W FLAGLER ST STE 3
MIAMI FL
33135-2098
US

IV. Provider business mailing address

1701 W FLAGLER ST STE 3
MIAMI FL
33135-2098
US

V. Phone/Fax

Practice location:
  • Phone: 305-649-4527
  • Fax:
Mailing address:
  • Phone: 305-649-4527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number3569317
License Number StateFL

VIII. Authorized Official

Name: ROSA FERNANDEZ
Title or Position: OPTICIAN
Credential:
Phone: 305-649-4527