Provider Demographics
NPI:1477850006
Name:JOSEFINA OPTICAL CENTER INC
Entity Type:Organization
Organization Name:JOSEFINA OPTICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUANA
Authorized Official - Middle Name:JOSEFINA
Authorized Official - Last Name:MUNIZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-884-3346
Mailing Address - Street 1:3025 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3207
Mailing Address - Country:US
Mailing Address - Phone:786-478-3554
Mailing Address - Fax:
Practice Address - Street 1:3025 CORAL WAY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3207
Practice Address - Country:US
Practice Address - Phone:786-478-3554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP1330152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078188601Medicaid
FLU26563Medicare UPIN
FL078188601Medicaid