Provider Demographics
NPI:1902084445
Name:DE ARMAS, FABIAN CEPERO (OD)
Entity Type:Individual
Prefix:
First Name:FABIAN
Middle Name:CEPERO
Last Name:DE ARMAS
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 1:3195 SW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-2711
Mailing Address - Country:US
Mailing Address - Phone:305-854-0110
Mailing Address - Fax:305-854-4877
Practice Address - Street 1:3195 SW 3RD AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129-2711
Practice Address - Country:US
Practice Address - Phone:305-854-0110
Practice Address - Fax:305-854-4877
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001076152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19331Medicare PIN