Provider Demographics
NPI:1750732673
Name:AMARAWARDANA, THARANIE (OD)
Entity type:Individual
Prefix:DR
First Name:THARANIE
Middle Name:
Last Name:AMARAWARDANA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10870 NW 88TH TER UNIT 202
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2116
Mailing Address - Country:US
Mailing Address - Phone:301-728-5863
Mailing Address - Fax:
Practice Address - Street 1:1846 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3418
Practice Address - Country:US
Practice Address - Phone:305-643-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2020-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5457152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics