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General NPI Number Information
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NPI Number | 1164634291
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Entity Type | Organization
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Legal Business Name | PBO ENTERPRISES INC.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2345 CORAL WAY
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City | MIAMI
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State | FL
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Zip | 33145
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Country | US
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Telephone | 305-858-4500
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Fax | 305-858-8999
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Provider Business Mailing Address
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Address Line | 2345 CORAL WAY
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City | MIAMI
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State | FL
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Zip | 33145
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Country | US
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Telephone | 305-858-4500
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Fax | 305-858-8999
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Authorized Official
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Title or Position | SECRETARY
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Name | C PEREZ-BLANCO
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Credential | D.O.
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Telephone | 305-858-4500
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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 | OPC3378
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License Number State | FL
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