Provider Demographics
NPI:1356003966
Name:PEREZ DE LA PENA, OBED EDUARDO (OD)
Entity Type:Individual
Prefix:
First Name:OBED
Middle Name:EDUARDO
Last Name:PEREZ DE LA PENA
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 1:2700 SW 36TH AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2771
Mailing Address - Country:US
Mailing Address - Phone:787-433-6745
Mailing Address - Fax:
Practice Address - Street 1:1097 S LE JEUNE RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33134-2639
Practice Address - Country:US
Practice Address - Phone:305-442-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC6011152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist