=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760267579
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OK LOVE MYOPIA CONTROL EXPERTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2023
-----------------------------------------------------
Last Update Date | 08/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 650 NW 180TH TER STE 103
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33029-2825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-544-7790
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 650 NW 180TH TER STE 103
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33029-2825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-544-7790
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GLENDA ALEMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-854-7910
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------