Healthcare Provider Details

I. General information

NPI: 1366879132
Provider Name (Legal Business Name): ANGELS OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2013
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 SW 1ST ST SUITE 107
MIAMI FL
33135-1694
US

IV. Provider business mailing address

2141 SW 1ST ST SUITE 107
MIAMI FL
33135-1694
US

V. Phone/Fax

Practice location:
  • Phone: 305-649-3336
  • Fax: 305-649-3929
Mailing address:
  • Phone: 305-649-3336
  • Fax: 305-649-3929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OMAR BENITEZ
Title or Position: OWNER
Credential: MD
Phone: 305-649-3336