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General NPI Number Information
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NPI Number | 1225574783
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Entity Type | Organization
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Legal Business Name | MIRAMAR VISION CENTER
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 9939 MIRAMAR PKWY
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City | MIRAMAR
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State | FL
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Zip | 33025-2397
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Country | US
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Telephone | 954-430-0430
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Fax | 954-430-0888
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Provider Business Mailing Address
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Address Line | 9939 MIRAMAR PKWY
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City | MIRAMAR
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State | FL
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Zip | 33025-2397
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Country | US
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Telephone | 954-430-0430
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Fax | 954-430-0888
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Authorized Official
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Title or Position | MANAGER
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Name | MS. DIOSE GONZALEZ
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Credential |
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Telephone | 954-430-0430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | OPC3651
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License Number State | FL
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