Provider Demographics
NPI:1801589262
Name:CAPO, JESLINE MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:JESLINE
Middle Name:MARIE
Last Name:CAPO
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 1:5411 SW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-6738
Mailing Address - Country:US
Mailing Address - Phone:305-785-4082
Mailing Address - Fax:
Practice Address - Street 1:4155 SW 130TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3417
Practice Address - Country:US
Practice Address - Phone:305-364-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL6279152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program