Healthcare Provider Details

I. General information

NPI: 1285293084
Provider Name (Legal Business Name): OPTICAL CENTER EXPRESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NW 17TH ST
MIAMI FL
33136-1119
US

IV. Provider business mailing address

900 NW 17TH ST
MIAMI FL
33136-1119
US

V. Phone/Fax

Practice location:
  • Phone: 305-326-6092
  • Fax:
Mailing address:
  • Phone: 305-326-6092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ANGEL PEREZ
Title or Position: MANAGER
Credential:
Phone: 305-401-2163