=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710339734
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAMELA MINKES OD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2016
-----------------------------------------------------
Last Update Date | 07/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7535 N KENDALL DR STE 2240
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156-7893
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-606-7267
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11734 SW 104TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-3601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-606-7267
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PAMELA MINKES
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 305-606-7267
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC3368
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------