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General NPI Number Information
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NPI Number | 1124321567
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Entity Type | Organization
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Legal Business Name | KATHERINE L. ORELLANA-MEDINA
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 01/27/2011
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Provider Practice Location Address
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Address Line | 11725 PINES BLVD OPTICAL
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-4110
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Country | US
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Telephone | 954-433-4883
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Fax | 954-431-7846
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Provider Business Mailing Address
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Address Line | 285 SW 180TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-3903
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Country | US
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Telephone | 917-584-7555
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KATHERINE ORELLANA-MEDINA
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Credential | O.D.
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Telephone | 917-584-7555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 3853
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License Number State | FL
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