Healthcare Provider Details

I. General information

NPI: 1598244907
Provider Name (Legal Business Name): EYES RIGHT OPTICIANS AND EYE DOCTORS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 NE MIAMI GARDENS DR
NORTH MIAMI BEACH FL
33179-5035
US

IV. Provider business mailing address

10860 NW 37TH CT
CORAL SPRINGS FL
33065-2701
US

V. Phone/Fax

Practice location:
  • Phone: 305-932-5602
  • Fax:
Mailing address:
  • Phone: 786-897-9472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4397
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC4425
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4425
License Number StateFL

VIII. Authorized Official

Name: DR. SMITH BLANC
Title or Position: PRESIDENT
Credential: OD
Phone: 786-897-9472