=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235632183
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCHNEIDER EYE CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2018
-----------------------------------------------------
Last Update Date | 04/10/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7450 SW 57TH AVE
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-5302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-662-9300
-----------------------------------------------------
Fax | 305-661-0081
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7450 SW 57TH AVE
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-5302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-310-5588
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | LLOYD SCHNEIDER
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 305-310-5588
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC1304
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------