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NPI Code Detail

MEDICARE: OPTIC PLANET LLC

MEDICARE: OPTIC PLANET LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11669133625OTHERFLNPI
21285159178OTHERFLNPI
31811144850OTHERFLNPI

General Provider Information

NPI Number : 1134800030
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPTIC PLANET LLC
Provider Business Mailing Address
First Line : 15332 NW 79TH CT
Second Line :
City : MIAMI LAKES
State : FL
Zip : 33016-5808
Country : US
Telephone Number : 305-821-0304
Fax Number : 305-558-0641
Provider Business Practice Location Address
First Line : 15332 NW 79TH CT
Second Line :
City : MIAMI LAKES
State : FL
Zip : 33016-5808
Country : US
Telephone Number : 305-821-0304
Fax Number : 305-558-0641
Authorized Official
Title or Position : BILLER
Name : MS. DENISE MARTIN
Credential :
Telephone Number : 305-821-0304
Provider Enumeration Date : 07/25/2023
Last Update Date : 07/26/2023

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Directions to “OPTIC PLANET LLC ” Practice Location

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