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General NPI Number Information
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NPI Number | 1376301515
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Entity Type | Individual
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Provider Name | VIRGINIA PERDOMO OPTICIAN
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Gender | Female
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Dates
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Enumeration Date | 03/12/2024
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Last Update Date | 04/18/2024
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Provider Practice Location Address
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Address Line | 3773 W FLAGLER ST
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City | CORAL GABLES
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State | FL
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Zip | 33134-1601
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Country | US
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Telephone | 786-357-6748
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Fax |
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Provider Business Mailing Address
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Address Line | 13973 SW 46TH TER APT C223
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City | MIAMI
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State | FL
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Zip | 33175-4433
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Country | US
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Telephone | 786-357-6748
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Fax |
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | OD7242
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License Number State | FL
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