=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033519186
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED VISION CARE OF KENDALL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2014
-----------------------------------------------------
Last Update Date | 07/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11605 N KENDALL DR
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-982-8927
-----------------------------------------------------
Fax | 305-647-6120
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11605 N KENDALL DR
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-982-8927
-----------------------------------------------------
Fax | 305-647-6120
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | AMIR CUKIERMAN
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 954-850-1454
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC2861
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------