Provider Demographics
NPI:1629260849
Name:BRICENO MARTIN, MARIA (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:BRICENO MARTIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:BRICENO MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14750 NW 77TH CT
Mailing Address - Street 2:STE 110
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1507
Mailing Address - Country:US
Mailing Address - Phone:305-825-2020
Mailing Address - Fax:305-556-0557
Practice Address - Street 1:14750 NW 77TH CT STE 110
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1507
Practice Address - Country:US
Practice Address - Phone:305-456-7313
Practice Address - Fax:305-640-5346
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-11
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4209152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000019400Medicaid