Provider Demographics
NPI:1295749182
Name:CORZO, LOURDES (OPTICIAN)
Entity type:Individual
Prefix:MS
First Name:LOURDES
Middle Name:
Last Name:CORZO
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2704
Mailing Address - Country:US
Mailing Address - Phone:305-643-5682
Mailing Address - Fax:
Practice Address - Street 1:1340 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3904
Practice Address - Country:US
Practice Address - Phone:305-858-5745
Practice Address - Fax:305-858-1955
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL989156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician