Provider Demographics
NPI:1104843994
Name:JUMET-ESTEVA, TERESA (LDO)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:JUMET-ESTEVA
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15600 NW 67TH AVE
Mailing Address - Street 2:210
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2174
Mailing Address - Country:US
Mailing Address - Phone:305-825-2020
Mailing Address - Fax:305-556-0557
Practice Address - Street 1:15600 NW 67TH AVE
Practice Address - Street 2:210
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2174
Practice Address - Country:US
Practice Address - Phone:305-825-2020
Practice Address - Fax:305-556-0557
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO1491156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL086853100Medicaid
FL0771360001Medicare NSC