Provider Demographics
NPI:1548470297
Name:CUEVAS, JESUS (OD)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:
Last Name:CUEVAS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:JESUS
Other - Middle Name:
Other - Last Name:CUEVAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1925 HIBISCUS LN
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-3545
Mailing Address - Country:US
Mailing Address - Phone:305-804-0645
Mailing Address - Fax:
Practice Address - Street 1:1608 TOWN CENTER BOULEVARD
Practice Address - Street 2:SUITE C
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33327
Practice Address - Country:US
Practice Address - Phone:954-384-1127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4122152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL 4122OtherEYEMED