Provider Demographics
NPI:1437105962
Name:LARIA, LIANETTE (OD)
Entity Type:Individual
Prefix:
First Name:LIANETTE
Middle Name:
Last Name:LARIA
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 1:8220 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 1:8220 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2028
Practice Address - Country:US
Practice Address - Phone:305-225-1145
Practice Address - Fax:305-225-5158
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3913152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620974200Medicaid
FLV03492Medicare UPIN
FLU4129ZMedicare PIN