Provider Demographics
NPI:1003846759
Name:ESPAILLAT MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:ESPAILLAT MEDICAL SERVICES LLC
Other - Org Name:DIABETES EYE CARE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPAILLAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-545-9393
Mailing Address - Street 1:1321 NW 14TH ST
Mailing Address - Street 2:SUITE 603
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1673
Mailing Address - Country:US
Mailing Address - Phone:305-545-9393
Mailing Address - Fax:305-547-2393
Practice Address - Street 1:1321 NW 14TH ST
Practice Address - Street 2:SUITE 603
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1673
Practice Address - Country:US
Practice Address - Phone:305-545-9393
Practice Address - Fax:305-547-2393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2749152W00000X
FLME81887207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274655700Medicaid
FL274655700Medicaid