Provider Demographics
NPI:1740531417
Name:CEPERO EYECARE CENTER, INC
Entity type:Organization
Organization Name:CEPERO EYECARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CEPERO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-858-4057
Mailing Address - Street 1:1705 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2728
Mailing Address - Country:US
Mailing Address - Phone:305-858-4057
Mailing Address - Fax:305-858-4053
Practice Address - Street 1:1705 CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2728
Practice Address - Country:US
Practice Address - Phone:305-858-4057
Practice Address - Fax:305-858-4053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4698152W00000X
FLDO3239332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty