Basic Information
| Provider Information | |||||||||
| NPI: | 1306024229 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAYA VISION CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 771 S STATE ROAD 7 | ||||||||
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| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333174000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545843838 | ||||||||
| FaxNumber: | 9545845011 | ||||||||
| Practice Location | |||||||||
| Address1: | 5831 SW 137TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331831105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545995905 | ||||||||
| FaxNumber: | 9545845011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2008 | ||||||||
| LastUpdateDate: | 02/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | MAYA | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9545995905 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | FL3250 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.