Provider Demographics
NPI:1578809091
Name:DR. JESSICA RIVERA O.D. P.A.
Entity Type:Organization
Organization Name:DR. JESSICA RIVERA O.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIVERA-ONORATI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-927-2020
Mailing Address - Street 1:599 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-4174
Mailing Address - Country:US
Mailing Address - Phone:954-927-2020
Mailing Address - Fax:954-927-3418
Practice Address - Street 1:599 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-4174
Practice Address - Country:US
Practice Address - Phone:954-927-2020
Practice Address - Fax:954-927-3418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4649152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty