Individual provider · NPI-1

Dr. Smith Blanc, O.D.

Optometrist · Hialeah, FL

NPI number1053644666
StatusActive
Last updated in NPPESJul 1, 2011

Details

NPI
1053644666
Entity type
Individual (NPI-1)
Name
Dr. Smith Blanc
Credential
O.D.
Sex
Male
Sole proprietor
Yes
Enumeration date
Sep 14, 2009
Last updated
Jul 1, 2011

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
152W00000X OptometristOPC4425FLYes
152WC0802X Optometrist, Corneal and Contact ManagementOPC4425FL

Practice location

18610 Nw 67th Ave
Hialeah, FL 33015-2406

Phone 305-474-0463 · Fax 305-474-8071

Mailing address

10860 Nw 37th Ct
Coral Springs, FL 33065-2701

Phone 786-897-9472

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