Provider Demographics
NPI:1659598548
Name:FRAGA, EDUARDO C (DO)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:C
Last Name:FRAGA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 N KROME AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4409
Mailing Address - Country:US
Mailing Address - Phone:305-248-5004
Mailing Address - Fax:305-248-8375
Practice Address - Street 1:944 N KROME AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4409
Practice Address - Country:US
Practice Address - Phone:305-248-5004
Practice Address - Fax:305-248-8375
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO1719156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid