Basic Information
| Provider Information | |||||||||
| NPI: | 1730530056 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANSITO | ||||||||
| FirstName: | CANDICE | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2896 S EDGEHILL LN | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330263773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7864865228 | ||||||||
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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: | 06/28/2016 | ||||||||
| LastUpdateDate: | 06/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPC5204 | FL | Y | Eye and Vision Services Providers | Optometrist | 152WC0802X | OPC5204 | FL | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management |
No ID Information.