MEDICARE: IZA OPTICAL LAB INC

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
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1235648544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IZA OPTICAL LAB INC

Provider Business Mailing Address
First Line	:	950 E 25TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-3404
Country	:	US
Telephone Number	:	305-696-1415
Fax Number	:	305-696-3999

Provider Business Practice Location Address
First Line	:	950 E 25TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-3404
Country	:	US
Telephone Number	:	305-696-1415
Fax Number	:	305-696-3999

Authorized Official
Title or Position	:	OPTICIAN
Name	:	AMARILIS T BATISTA
Credential	:	DO
Telephone Number	:	305-696-1415

Provider Enumeration Date	:	09/29/2017
Last Update Date	:	07/21/2022

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Directions to “IZA OPTICAL LAB INC ” Practice Location

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