MEDICARE: CUSABA VISION A PLUS 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	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689389108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUSABA VISION A PLUS INC

Provider Business Mailing Address
First Line	:	16900 NW 78TH AVE
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-8446
Country	:	US
Telephone Number	:	512-276-4681
Fax Number	:

Provider Business Practice Location Address
First Line	:	1165 W 49TH ST STE 210
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3373
Country	:	US
Telephone Number	:	786-931-4606
Fax Number	:	786-786-1022

Authorized Official
Title or Position	:	OWNER
Name	:	ABEL CABRERA-MARTINEZ
Credential	:	MD
Telephone Number	:	512-276-4681

Provider Enumeration Date	:	01/18/2023
Last Update Date	:	09/26/2024

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