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General NPI Number Information
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NPI Number | 1235552142
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Entity Type | Individual
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Provider Name | JAVIER ARCHILLA O.D
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Gender | Male
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Dates
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Enumeration Date | 01/28/2014
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 101 NW 57TH AVE
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City | MIAMI
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State | FL
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Zip | 33126-4804
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Country | US
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Telephone | 305-239-2515
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Fax |
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Provider Business Mailing Address
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Address Line | 101 NW 57TH AVE
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City | MIAMI
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State | FL
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Zip | 33126-4804
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Country | US
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Telephone | 305-239-2515
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 703-320
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License Number State | PR
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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 | OPC 4896
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License Number State | FL
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