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General NPI Number Information
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NPI Number | 1528506672
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Entity Type | Organization
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Legal Business Name | LTA VISION CORPORATION
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 19505 BISCAYNE BLVD INSIDE SEARS OPTICAL
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City | AVENTURA
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State | FL
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Zip | 33180-2314
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Country | US
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Telephone | 305-935-4606
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Fax |
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Provider Business Mailing Address
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Address Line | 7265 NW 173RD DR APT 712
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City | HIALEAH
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State | FL
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Zip | 33015-8405
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Country | US
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Telephone | 786-280-5923
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LINA TATIANA ARANGO
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Credential | O.D.
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Telephone | 786-280-5923
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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 4793
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License Number State | FL
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