Provider Demographics
NPI:1871190694
Name:ROBERTO PONCE, OD PA
Entity Type:Organization
Organization Name:ROBERTO PONCE, OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:PONCE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-649-0555
Mailing Address - Street 1:2903 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4305
Mailing Address - Country:US
Mailing Address - Phone:305-649-0555
Mailing Address - Fax:305-642-3460
Practice Address - Street 1:2903 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4305
Practice Address - Country:US
Practice Address - Phone:305-649-0555
Practice Address - Fax:305-642-3460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty