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General NPI Number Information
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NPI Number | 1346564325
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Entity Type | Organization
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Legal Business Name | CORAL SPRINGS VISION CARE PLLC
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Dates
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Enumeration Date | 03/20/2010
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Last Update Date | 10/30/2013
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Provider Practice Location Address
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Address Line | 9773 W SAMPLE RD
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4003
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Country | US
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Telephone | 954-753-0137
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Fax | 954-753-0139
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Provider Business Mailing Address
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Address Line | 9773 W SAMPLE RD
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4003
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Country | US
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Telephone | 954-753-0137
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Fax | 954-753-0139
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | DR. KATHERINE ORELLANA-MEDINA
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Credential | O.D.
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Telephone | 954-753-0137
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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 | OPC 3853
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License Number State | FL
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