Provider Demographics
NPI:1336631340
Name:DASILVA, JUSTIN PIERRE (OD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:PIERRE
Last Name:DASILVA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19631 SW 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-4142
Mailing Address - Country:US
Mailing Address - Phone:954-817-2862
Mailing Address - Fax:
Practice Address - Street 1:9729 NW 41ST ST STE 23
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2944
Practice Address - Country:US
Practice Address - Phone:305-470-2999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC005524152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist