Provider Demographics
NPI:1326715251
Name:DR LIANETTE LARIA PA
Entity Type:Organization
Organization Name:DR LIANETTE LARIA PA
Other - Org Name:LARIA EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-225-1145
Mailing Address - Street 1:8220 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2028
Mailing Address - Country:US
Mailing Address - Phone:305-225-1145
Mailing Address - Fax:305-225-5158
Practice Address - Street 1:5785 BIRD RD STE B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5334
Practice Address - Country:US
Practice Address - Phone:305-225-1145
Practice Address - Fax:305-225-5158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-27
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009067400Medicaid
FL620974200Medicaid
FL009067402Medicaid