Basic Information
| Provider Information | |||||||||
| NPI: | 1215343546 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDUARDO | ||||||||
| FirstName: | GINETTE | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5057 N DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | OAKLAND PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333344003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544891042 | ||||||||
| FaxNumber: | 9544891071 | ||||||||
| Practice Location | |||||||||
| Address1: | 5057 N DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | OAKLAND PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333344003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544891042 | ||||||||
| FaxNumber: | 9544891071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2014 | ||||||||
| LastUpdateDate: | 03/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPC4950 | FL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.