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General NPI Number Information
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NPI Number | 1679298269
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Entity Type | Organization
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Legal Business Name | OPTIC WISE CORP
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Dates
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Enumeration Date | 10/06/2022
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 13858 SW 56TH ST
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City | MIAMI
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State | FL
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Zip | 33175-6060
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Country | US
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Telephone | 786-391-0980
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Fax | 786-221-0415
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Provider Business Mailing Address
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Address Line | 13858 SW 56TH ST
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City | MIAMI
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State | FL
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Zip | 33175-6060
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Country | US
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Telephone | 786-391-0980
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Fax | 786-221-0415
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Authorized Official
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Title or Position | OPTICIAN
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Name | MRS. LAURA FIGUEROA
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Credential | DO
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Telephone | 786-391-0980
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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 |
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License Number State |
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