Basic Information
| Provider Information | |||||||||
| NPI: | 1356003966 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEREZ DE LA PENA | ||||||||
| FirstName: | OBED | ||||||||
| MiddleName: | EDUARDO | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 SW 36TH AVE UNIT B | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331332771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874336745 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1097 S LE JEUNE RD | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331342639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054422020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2021 | ||||||||
| LastUpdateDate: | 10/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPC6011 | FL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.