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General NPI Number Information
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NPI Number | 1215798301
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Entity Type | Organization
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Legal Business Name | DESIGNER COLLECTION OPTICAL
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Dates
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Enumeration Date | 01/17/2024
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 15470 NW 77TH CT
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City | MIAMI LAKES
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State | FL
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Zip | 33016-5823
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Country | US
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Telephone | 786-564-2439
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Fax |
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Provider Business Mailing Address
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Address Line | 15470 NW 77TH CT
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City | MIAMI LAKES
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State | FL
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Zip | 33016-5823
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Country | US
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Telephone | 786-564-2439
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Fax |
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Authorized Official
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Title or Position | SECRETARY/OPTICIAN
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Name | MISS MITZANIA POLANCO
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Credential | DO6785
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Telephone | 786-564-2439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 156FC0800X
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Taxonomy Name | Contact Lens Technician/Technologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 156FC0801X
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Taxonomy Name | Contact Lens Fitter
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License Number |
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License Number State |
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Taxonomy #4
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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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