Provider Demographics
NPI:1548795834
Name:IVANA ESTRADA OD PA
Entity type:Organization
Organization Name:IVANA ESTRADA OD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-279-2212
Mailing Address - Street 1:10521 N KENDALL DR
Mailing Address - Street 2:STE E103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1599
Mailing Address - Country:US
Mailing Address - Phone:305-279-2212
Mailing Address - Fax:
Practice Address - Street 1:10521 N KENDALL DR
Practice Address - Street 2:STE E103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1599
Practice Address - Country:US
Practice Address - Phone:305-279-2212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4978152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty