Provider Demographics
NPI:1407956048
Name:DE LA TORRE, MIGUEL ENRIQUE (OD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ENRIQUE
Last Name:DE LA TORRE
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 1:13641 SW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6378
Mailing Address - Country:US
Mailing Address - Phone:305-559-1314
Mailing Address - Fax:305-559-1397
Practice Address - Street 1:13641 SW 26TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6378
Practice Address - Country:US
Practice Address - Phone:305-559-1314
Practice Address - Fax:305-559-1397
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3580152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist