Provider Demographics
NPI:1497772685
Name:MIAMI LAKES EYE CARE CENTER PA
Entity Type:Organization
Organization Name:MIAMI LAKES EYE CARE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMBRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-825-2020
Mailing Address - Street 1:15600 NW 67TH AVE
Mailing Address - Street 2:210
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2174
Mailing Address - Country:US
Mailing Address - Phone:305-825-2020
Mailing Address - Fax:305-556-0557
Practice Address - Street 1:15600 NW 67TH AVE
Practice Address - Street 2:210
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2174
Practice Address - Country:US
Practice Address - Phone:305-825-2020
Practice Address - Fax:305-556-0557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC002421152W00000X
FLOPC004209152W00000X
FLME0047462207W00000X
FLME0047681207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057288800Medicaid
FL0771360001Medicare NSC
FLK5637Medicare PIN