Provider Demographics
NPI:1841614872
Name:ZAMBRANO, WILLIAM JR (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:ZAMBRANO
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15600 NW 67TH AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2174
Mailing Address - Country:US
Mailing Address - Phone:305-825-2020
Mailing Address - Fax:305-556-0557
Practice Address - Street 1:15600 NW 67TH AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2174
Practice Address - Country:US
Practice Address - Phone:305-825-2020
Practice Address - Fax:305-556-0557
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 004908152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012036200Medicaid
FL012036200Medicaid