Provider Demographics
NPI:1841596541
Name:ILLUSION OPTICAL DESIGN, INC.
Entity Type:Organization
Organization Name:ILLUSION OPTICAL DESIGN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:JESUS
Authorized Official - Last Name:ALLENDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-262-0606
Mailing Address - Street 1:7931 SW BIRD ROAD
Mailing Address - Street 2:#37
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6748
Mailing Address - Country:US
Mailing Address - Phone:305-262-0606
Mailing Address - Fax:305-262-0996
Practice Address - Street 1:7931 SW BIRD ROAD
Practice Address - Street 2:#37
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6748
Practice Address - Country:US
Practice Address - Phone:305-262-0606
Practice Address - Fax:305-262-0996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34547152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty