=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316509706
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMANDA REYES OD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2019
-----------------------------------------------------
Last Update Date | 07/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8485 SW 40TH ST STE 103
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-3262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-223-6142
-----------------------------------------------------
Fax | 305-552-0824
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8485 SW 40TH ST STE 103
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-3262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-223-6142
-----------------------------------------------------
Fax | 305-552-0824
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIC PHYSICIAN
-----------------------------------------------------
Name | DR. AMANDA REYES
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 305-801-8848
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------