Provider Demographics
NPI:1306024229
Name:MAYA VISION CENTER, INC.
Entity Type:Organization
Organization Name:MAYA VISION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-599-5905
Mailing Address - Street 1:771 S STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-4000
Mailing Address - Country:US
Mailing Address - Phone:954-584-3838
Mailing Address - Fax:954-584-5011
Practice Address - Street 1:5831 SW 137TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-1105
Practice Address - Country:US
Practice Address - Phone:954-599-5905
Practice Address - Fax:954-584-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL3250152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8131Medicare PIN