Provider Demographics
NPI:1871009720
Name:ADRAS, ADRESSANT
Entity Type:Individual
Prefix:
First Name:ADRESSANT
Middle Name:
Last Name:ADRAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 W HALLANDALE BEACH BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4344
Mailing Address - Country:US
Mailing Address - Phone:305-469-4596
Mailing Address - Fax:
Practice Address - Street 1:4520 W HALLANDALE BEACH BLVD STE 8
Practice Address - Street 2:
Practice Address - City:PEMBROKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33023-4344
Practice Address - Country:US
Practice Address - Phone:305-469-4596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5161156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician