=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285866145
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EL RETORNO OPTICAL DISCOUNT , INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2009
-----------------------------------------------------
Last Update Date | 08/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8353 SW 40TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-3352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-559-0613
-----------------------------------------------------
Fax | 305-559-0614
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8353 SW 40TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-3352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-559-0613
-----------------------------------------------------
Fax | 305-559-0614
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VPRESIDENT
-----------------------------------------------------
Name | DALIA LURBE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-559-0613
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | DO2997
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------