Provider Demographics
NPI:1619442845
Name:VIP OPTICA CORAL WAY, INC.
Entity Type:Organization
Organization Name:VIP OPTICA CORAL WAY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARCHILLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-262-6272
Mailing Address - Street 1:6741 SW 24TH ST STE 54
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1768
Mailing Address - Country:US
Mailing Address - Phone:305-262-6272
Mailing Address - Fax:786-615-9177
Practice Address - Street 1:6741 SW 24TH ST STE 54
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1768
Practice Address - Country:US
Practice Address - Phone:305-262-6272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center