Provider Demographics
NPI:1548576036
Name:OLIVE, ZURIANY IVELISSES (OD)
Entity Type:Individual
Prefix:DR
First Name:ZURIANY
Middle Name:IVELISSES
Last Name:OLIVE
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 1:8228 SW 190TH TER
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7540
Mailing Address - Country:US
Mailing Address - Phone:305-253-9038
Mailing Address - Fax:305-971-2577
Practice Address - Street 1:7875 SW 104TH ST STE 204
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2642
Practice Address - Country:US
Practice Address - Phone:305-253-9038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4544152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003076501Medicaid
FLFL717AMedicare PIN