Provider Demographics
NPI:1104205376
Name:SANTA MARIA OPTICAL
Entity Type:Organization
Organization Name:SANTA MARIA OPTICAL
Other - Org Name:VISION WORLD OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:ARENCIBIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-504-1505
Mailing Address - Street 1:7367 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4539
Mailing Address - Country:US
Mailing Address - Phone:305-265-7778
Mailing Address - Fax:305-265-7778
Practice Address - Street 1:7367 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4539
Practice Address - Country:US
Practice Address - Phone:305-265-7778
Practice Address - Fax:305-265-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier