Provider Demographics
NPI:1679298269
Name:OPTIC WISE CORP
Entity type:Organization
Organization Name:OPTIC WISE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:786-391-0980
Mailing Address - Street 1:13858 SW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6060
Mailing Address - Country:US
Mailing Address - Phone:786-391-0980
Mailing Address - Fax:786-221-0415
Practice Address - Street 1:13858 SW 56TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6060
Practice Address - Country:US
Practice Address - Phone:786-391-0980
Practice Address - Fax:786-221-0415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDO7744Medicaid
FLOE2723Medicaid