Provider Demographics
NPI:1215189055
Name:DR AMARELLA E DALMAZZO OD PA
Entity Type:Organization
Organization Name:DR AMARELLA E DALMAZZO OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMARELLA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DALMAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-829-3937
Mailing Address - Street 1:18600 NW 87TH AVE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3512
Mailing Address - Country:US
Mailing Address - Phone:305-829-3937
Mailing Address - Fax:305-829-3927
Practice Address - Street 1:18600 NW 87TH AVE
Practice Address - Street 2:SUITE 124
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33015-3512
Practice Address - Country:US
Practice Address - Phone:305-829-3937
Practice Address - Fax:305-829-3927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4089152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAX155Medicare PIN