Provider Demographics
NPI:1417471806
Name:ANDVIN.LLC
Entity Type:Organization
Organization Name:ANDVIN.LLC
Other - Org Name:COHEN FASHION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA ANTONIETA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE FALCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-820-5869
Mailing Address - Street 1:1665 W 49TH ST STE 1408
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2957
Mailing Address - Country:US
Mailing Address - Phone:305-820-5869
Mailing Address - Fax:888-789-9309
Practice Address - Street 1:1665 W 49TH ST STE 1408
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2957
Practice Address - Country:US
Practice Address - Phone:305-820-5869
Practice Address - Fax:888-789-9309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier