Provider Demographics
NPI:1922101856
Name:GITLAN, RONALD (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:GITLAN
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10954 NW 7TH AVE
Mailing Address - Street 2:PRISM OPTICAL
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-2108
Mailing Address - Country:US
Mailing Address - Phone:305-754-5894
Mailing Address - Fax:305-754-7352
Practice Address - Street 1:10954 NW 7TH AVE
Practice Address - Street 2:PRISM OPTICAL
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-2108
Practice Address - Country:US
Practice Address - Phone:305-754-5894
Practice Address - Fax:305-754-7352
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1179156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician