Provider Demographics
NPI:1750634234
Name:OPTICA NICARAGUENSE
Entity Type:Organization
Organization Name:OPTICA NICARAGUENSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARGENTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-559-3942
Mailing Address - Street 1:10404 W FLAGLER ST STE 14
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1667
Mailing Address - Country:US
Mailing Address - Phone:305-559-3942
Mailing Address - Fax:305-559-3053
Practice Address - Street 1:10404 W FLAGLER ST STE 14
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1667
Practice Address - Country:US
Practice Address - Phone:305-559-3942
Practice Address - Fax:305-559-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-20
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL086836100Medicaid