Provider Demographics
NPI:1801984059
Name:FARAG, MIRIAM HALIM (OD)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:HALIM
Last Name:FARAG
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 1:10443 TRIANON PL
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8075
Mailing Address - Country:US
Mailing Address - Phone:954-536-8587
Mailing Address - Fax:
Practice Address - Street 1:10443 TRIANON PL
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8075
Practice Address - Country:US
Practice Address - Phone:954-536-8587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4021152WP0200X
FLOPC4021152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics