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General NPI Number Information
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NPI Number | 1003552860
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Entity Type | Organization
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Legal Business Name | SUPERVISTA NORTH AMERICA
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Dates
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Enumeration Date | 05/05/2022
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 7146 SW 117TH AVE
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City | MIAMI
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State | FL
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Zip | 33183
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Country | US
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Telephone | 786-776-4573
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Fax |
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Provider Business Mailing Address
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Address Line | 16 TECHNOLOGY DR STE 130
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City | IRVINE
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State | CA
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Zip | 92618-2325
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Country | US
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Telephone | 949-441-4021
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Fax |
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Authorized Official
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Title or Position | COO
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Name | KOUROSH ZAKERI
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Credential |
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Telephone | 949-441-4021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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