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General NPI Number Information
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NPI Number | 1851597611
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Entity Type | Organization
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Legal Business Name | SUNNY ISLES EYE CENTER INC
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 03/10/2017
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Provider Practice Location Address
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Address Line | 17100 COLLINS AVE #112
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City | SUNNY ISLES BEACH
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State | FL
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Zip | 33160-3675
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Country | US
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Telephone | 305-917-1037
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Fax | 305-917-1337
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Provider Business Mailing Address
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Address Line | 17100 COLLINS AVE #112
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City | SUNNY ISLES BEACH
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State | FL
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Zip | 33160-3675
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Country | US
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Telephone | 305-917-1037
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Fax | 305-917-1337
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Authorized Official
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Title or Position | OPTOMETRIS
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Name | DR. MARINA YAGUDAEV
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Credential | O. D.
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Telephone | 305-917-1037
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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 | OPC3753
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License Number State | FL
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