Provider Demographics
NPI:1639295371
Name:BENARD-ZELEDON, LUCY JEANETTE (OD)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:JEANETTE
Last Name:BENARD-ZELEDON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LUCY
Other - Middle Name:JEANETTE
Other - Last Name:BENARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:14974 SW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2505
Mailing Address - Country:US
Mailing Address - Phone:786-999-4205
Mailing Address - Fax:
Practice Address - Street 1:13600 SW 288TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033
Practice Address - Country:US
Practice Address - Phone:305-248-8883
Practice Address - Fax:844-814-2970
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3685152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620785500Medicaid
FL620785501Medicaid
FL620785501Medicaid