Provider Demographics
NPI:1609961291
Name:MIRANDA, SHARLENE MONIQUE (OD)
Entity Type:Individual
Prefix:DR
First Name:SHARLENE
Middle Name:MONIQUE
Last Name:MIRANDA
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:URB. LA ALHAMBRA
Mailing Address - Street 2:2519 OBISPADO AVE.
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-3840
Mailing Address - Country:US
Mailing Address - Phone:787-396-0177
Mailing Address - Fax:
Practice Address - Street 1:INFINITY LASER CENTER
Practice Address - Street 2:CITY VIEW PLAZA LOBBY SUITE 117
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-775-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR630152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist