Provider Demographics
NPI:1215411822
Name:CHARIS OPTICAL LLC
Entity Type:Organization
Organization Name:CHARIS OPTICAL LLC
Other - Org Name:PHYSICAL THERAPY NOW OF NORTH MIAMI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBOIS BRUTUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-710-8820
Mailing Address - Street 1:14870 SW 149TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2359
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2170 NE 123RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2902
Practice Address - Country:US
Practice Address - Phone:305-570-1666
Practice Address - Fax:305-203-0546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2019-07-19
Deactivation Date:2019-07-03
Deactivation Code:
Reactivation Date:2019-07-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT11471OtherMEDICAL LICENSE