Healthcare Provider Details

I. General information

NPI: 1215312111
Provider Name (Legal Business Name): ASHLEY MARI KATSIKOS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 SOLE MIA WAY
NORTH MIAMI FL
33181-2492
US

IV. Provider business mailing address

2111 SOLE MIA WAY
NORTH MIAMI FL
33181-2492
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-4000
  • Fax:
Mailing address:
  • Phone: 305-243-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC6651
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: