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General NPI Number Information
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NPI Number | 1750772174
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Entity Type | Organization
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Legal Business Name | LESLY'S OPTICAL INC
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Dates
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Enumeration Date | 02/06/2015
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Last Update Date | 02/06/2015
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Provider Practice Location Address
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Address Line | 1407 SW 107TH AVE
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City | MIAMI
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State | FL
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Zip | 33174-2509
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Country | US
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Telephone | 305-552-5595
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Fax | 305-552-9563
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Provider Business Mailing Address
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Address Line | 1407 SW 107 AVE
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City | MIAMI
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State | FL
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Zip | 33174
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Country | US
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Telephone | 305-552-5595
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Fax | 305-552-9563
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Authorized Official
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Title or Position | OPTICIAN
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Name | MS. LESLY ACELA GARCIA
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Credential |
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Telephone | 305-552-5595
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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 | 2165
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License Number State | FL
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