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General NPI Number Information
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NPI Number | 1255460929
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Entity Type | Individual
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Provider Name | MATTHEW J. FENSIN O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 13767 SW 152ND ST
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City | MIAMI
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State | FL
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Zip | 33177-8126
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Country | US
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Telephone | 305-255-8822
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Fax | 305-255-9507
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Provider Business Mailing Address
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Address Line | 13767 SW 152ND ST
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City | MIAMI
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State | FL
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Zip | 33177-8126
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Country | US
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Telephone | 305-255-8822
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Fax | 305-255-9507
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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 | OPC1148
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License Number State | FL
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