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General NPI Number Information
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NPI Number | 1215421417
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Entity Type | Organization
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Legal Business Name | THE OPTICAL PROFESSIONALS, LLC
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 790 NE 147TH ST
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City | NORTH MIAMI
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State | FL
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Zip | 33161-2363
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Country | US
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Telephone | 954-707-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 790 NE 147TH ST
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City | NORTH MIAMI
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State | FL
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Zip | 33161-2363
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Country | US
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Telephone | 954-707-3800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KIRAN GOLDING
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Credential | LDO
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Telephone | 954-707-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO-7010
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | DO-7010
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License Number State | FL
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