Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO4712 | FL |
NPI | 1174074694 |
---|---|
Provider Name | Manuel Perez |
First Address | North Miami Beach, FL 33179-1268 |
Second Address | Miami Gardens, FL 33055-3045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2016 |
Last Update Date | 19/10/2016 |