Provider Demographics
NPI:1750873519
Name:ELIAS, FERNANDO (OD)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:ELIAS
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 1:13865 SW 64TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-1182
Mailing Address - Country:US
Mailing Address - Phone:305-799-2723
Mailing Address - Fax:
Practice Address - Street 1:13865 SW 64TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-1182
Practice Address - Country:US
Practice Address - Phone:305-799-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist