Provider Demographics
NPI:1346266780
Name:TORAL, ILIANA (OD)
Entity Type:Individual
Prefix:DR
First Name:ILIANA
Middle Name:
Last Name:TORAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12822 SW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-5607
Mailing Address - Country:US
Mailing Address - Phone:954-430-7338
Mailing Address - Fax:954-430-1417
Practice Address - Street 1:1951 NW 150TH AVE
Practice Address - Street 2:SUITE B102
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2875
Practice Address - Country:US
Practice Address - Phone:954-430-7338
Practice Address - Fax:954-430-1417
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3615152W00000X, 152WC0802X, 152WL0500X, 152WS0006X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620833900Medicaid
FL620833900Medicaid
FLU97088Medicare UPIN