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General NPI Number Information
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NPI Number | 1215785811
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Entity Type | Organization
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Legal Business Name | 2010 OPTICAL GROUP LLC
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Dates
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Enumeration Date | 05/08/2024
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 5645 NW 87TH AVE SUITE 100
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City | DORAL
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State | FL
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Zip | 33178
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Country | US
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Telephone | 305-362-4020
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Fax | 305-362-2592
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Provider Business Mailing Address
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Address Line | 5645 NW 87TH AVE SUITE 100
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City | DORAL
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State | FL
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Zip | 33178
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMUEL SALAS
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Credential |
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Telephone | 305-362-4020
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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