Provider Demographics
NPI:1619126646
Name:INFINITI VISION CENTER
Entity Type:Organization
Organization Name:INFINITI VISION CENTER
Other - Org Name:PEARLE VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:CADET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-474-0433
Mailing Address - Street 1:18610 NW 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2406
Mailing Address - Country:US
Mailing Address - Phone:305-474-0433
Mailing Address - Fax:305-474-8071
Practice Address - Street 1:18610 NW 67TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33015
Practice Address - Country:US
Practice Address - Phone:305-474-0433
Practice Address - Fax:305-474-8071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO4551156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL630147900Medicaid
FLOP2079OtherEYE MED VISION CARE