Provider Demographics
NPI:1972703841
Name:RAMIREZ, LISA JEANINE (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:JEANINE
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10524 SW 132ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3443
Mailing Address - Country:US
Mailing Address - Phone:305-992-2825
Mailing Address - Fax:
Practice Address - Street 1:8501 SW 124TH AVE
Practice Address - Street 2:SUITE #109
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4627
Practice Address - Country:US
Practice Address - Phone:305-271-4544
Practice Address - Fax:305-964-6755
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3826152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620891600Medicaid
FL620891600Medicaid
FLU86687Medicare UPIN