1162 Military Trail LLC

NPI #1962748244 in Miami, Florida

Provider Information

NPI Number: 1962748244
Entity Type: Organization
Organization Name: 1162 Military Trail LLC
Primary Specialty: Ophthalmology
Enumeration Date: Dec 14, 2012
Last Updated: Dec 14, 2012

Practice Location

Address: 1661 SW 37TH AVE
Address 2: #102
City: Miami
State: Florida
ZIP Code: 33145-1754
Phone: (305) 774-0891

Authorized Official

Name: ERICA PERREIRA
Title: CHIEF OPERATING OFFICER
Phone: (877) 881-0022

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X
Ophthalmology	207W00000X	Primary

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