Provider Demographics
NPI:1740051259
Name:EXPRESSIVE EYES LLC
Entity type:Organization
Organization Name:EXPRESSIVE EYES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVANKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-748-5185
Mailing Address - Street 1:3940 NW 79TH AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6421
Mailing Address - Country:US
Mailing Address - Phone:305-748-5185
Mailing Address - Fax:
Practice Address - Street 1:15601 SW 127TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1406
Practice Address - Country:US
Practice Address - Phone:786-250-3217
Practice Address - Fax:786-250-3249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty