Provider Demographics
NPI:1154001246
Name:ALEMU, TINSAE (OD)
Entity type:Individual
Prefix:DR
First Name:TINSAE
Middle Name:
Last Name:ALEMU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19275 NW 27TH AVE APT 4105
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-2584
Mailing Address - Country:US
Mailing Address - Phone:614-869-8861
Mailing Address - Fax:
Practice Address - Street 1:18212 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-3501
Practice Address - Country:US
Practice Address - Phone:786-654-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC6278152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist