Provider Demographics
NPI:1881232106
Name:GARCIA, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:4715 SW 62ND AVE # 3101
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4460
Mailing Address - Country:US
Mailing Address - Phone:954-646-2847
Mailing Address - Fax:
Practice Address - Street 1:6618 STIRLING RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-1954
Practice Address - Country:US
Practice Address - Phone:954-812-9232
Practice Address - Fax:954-374-6783
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5866156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician