Provider Demographics
NPI:1922069095
Name:LIANNE M. PINO O.D., P.A.
Entity Type:Organization
Organization Name:LIANNE M. PINO O.D., P.A.
Other - Org Name:EXCEPTIONAL VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PINO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:786-242-7755
Mailing Address - Street 1:9000 SW 152ND ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1981
Mailing Address - Country:US
Mailing Address - Phone:786-242-7755
Mailing Address - Fax:786-242-0070
Practice Address - Street 1:9000 SW 152ND ST
Practice Address - Street 2:SUITE 206
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1981
Practice Address - Country:US
Practice Address - Phone:786-242-7755
Practice Address - Fax:786-242-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3390152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620934300Medicaid
FL620934300Medicaid
FLK5225Medicare PIN