Provider Demographics
NPI:1114249216
Name:TERESITA A BOLLAR OD PA
Entity Type:Organization
Organization Name:TERESITA A BOLLAR OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOLLAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-301-1198
Mailing Address - Street 1:1611 SW 97TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7635
Mailing Address - Country:US
Mailing Address - Phone:305-301-1198
Mailing Address - Fax:
Practice Address - Street 1:11241 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4477
Practice Address - Country:US
Practice Address - Phone:786-431-1625
Practice Address - Fax:786-431-1782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001540300Medicaid
FL001540300Medicaid