Provider Demographics
NPI:1609961028
Name:BEN-NISSAN, MEIR (OD)
Entity Type:Individual
Prefix:DR
First Name:MEIR
Middle Name:
Last Name:BEN-NISSAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3491 NE 163RD ST
Mailing Address - Street 2:
Mailing Address - City:N MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4426
Mailing Address - Country:US
Mailing Address - Phone:305-538-1201
Mailing Address - Fax:305-531-9703
Practice Address - Street 1:3491 NE 163RD ST
Practice Address - Street 2:
Practice Address - City:N MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4426
Practice Address - Country:US
Practice Address - Phone:305-538-1201
Practice Address - Fax:305-531-9703
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2605152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078918600Medicaid
FL20386XMedicare PIN