Provider Demographics
NPI:1316563695
Name:GITLAN, MIHAI (OD)
Entity Type:Individual
Prefix:
First Name:MIHAI
Middle Name:
Last Name:GITLAN
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 1:3004 NW 130TH TER APT 438
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3951
Mailing Address - Country:US
Mailing Address - Phone:719-201-5117
Mailing Address - Fax:
Practice Address - Street 1:3004 NW 130TH TER
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-3932
Practice Address - Country:US
Practice Address - Phone:719-201-5117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5806152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist