Provider Demographics
NPI:1356791362
Name:CHAUNTEL DA SILVA OD INC
Entity type:Organization
Organization Name:CHAUNTEL DA SILVA OD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PD/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:CHAUNTEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DA SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-470-2777
Mailing Address - Street 1:8810 NW 155TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1411
Mailing Address - Country:US
Mailing Address - Phone:305-815-9755
Mailing Address - Fax:
Practice Address - Street 1:9729 NW 41ST ST # 23
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178
Practice Address - Country:US
Practice Address - Phone:305-470-2777
Practice Address - Fax:305-470-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2018-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4307152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006682000Medicaid