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General NPI Number Information
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NPI Number | 1003902628
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Entity Type | Organization
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Legal Business Name | QUANTUM VISION CARE LLC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 1332 W FLAGLER ST
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City | MIAMI
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State | FL
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Zip | 33135-2320
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Country | US
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Telephone | 305-649-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 2945 SW 8 STREET
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City | MIAMI
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State | FL
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Zip | 33135-2826
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Country | US
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Telephone | 305-649-4900
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Fax | 305-649-2352
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Authorized Official
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Title or Position | MBR
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Name | CARLOS A VALDES-LORA
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Credential |
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Telephone | 305-649-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 39659
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License Number State | FL
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