Provider Demographics
NPI:1255689691
Name:CEPERO, ERNESTO (OD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:
Last Name:CEPERO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2728
Mailing Address - Country:US
Mailing Address - Phone:305-858-4085
Mailing Address - Fax:305-858-4053
Practice Address - Street 1:1705 CORAL WAY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-2728
Practice Address - Country:US
Practice Address - Phone:305-858-4085
Practice Address - Fax:305-858-4053
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4698152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist