=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417471806
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDVIN.LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1665 W 49TH ST STE 1408
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-2957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-820-5869
-----------------------------------------------------
Fax | 888-789-9309
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1665 W 49TH ST STE 1408
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-2957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-820-5869
-----------------------------------------------------
Fax | 888-789-9309
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MARIA ANTONIETA DE FALCO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-820-5869
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------