Provider Demographics
NPI:1356929343
Name:BREAD OF LIFE VISION LLC
Entity type:Organization
Organization Name:BREAD OF LIFE VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:786-250-3217
Mailing Address - Street 1:16448 SW 67TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5591
Mailing Address - Country:US
Mailing Address - Phone:786-250-3217
Mailing Address - Fax:786-250-3249
Practice Address - Street 1:15601 SW 127TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1406
Practice Address - Country:US
Practice Address - Phone:786-250-3217
Practice Address - Fax:786-250-3249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty