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General NPI Number Information
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NPI Number | 1831466358
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Entity Type | Organization
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Legal Business Name | MIAMI SHORES OPTICAL INC.
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Dates
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Enumeration Date | 11/29/2011
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Last Update Date | 11/29/2011
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Provider Practice Location Address
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Address Line | 9440 NE 2ND AVE
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City | MIAMI SHORES
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State | FL
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Zip | 33138-2703
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Country | US
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Telephone | 786-313-3048
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Fax | 786-313-3051
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Provider Business Mailing Address
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Address Line | 9440 NE 2ND AVE
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City | MIAMI SHORES
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State | FL
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Zip | 33138-2703
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Country | US
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Telephone | 786-313-3048
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Fax | 786-313-3051
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. COURTNEY CONSTANTINE WILLIAMS
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Credential | O.D.
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Telephone | 786-313-3048
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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 3388
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License Number State | FL
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