Provider Demographics
NPI:1265717102
Name:SILVA, JUAN CARLOS (DO)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:SILVA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 SW 124TH AVE
Mailing Address - Street 2:SUITE 109A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4627
Mailing Address - Country:US
Mailing Address - Phone:305-271-4544
Mailing Address - Fax:
Practice Address - Street 1:8501 SW 124TH AVE
Practice Address - Street 2:SUITE 109A
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:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6309156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician