Provider Demographics
NPI:1215798301
Name:DESIGNER COLLECTION OPTICAL
Entity type:Organization
Organization Name:DESIGNER COLLECTION OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/OPTICIAN
Authorized Official - Prefix:MISS
Authorized Official - First Name:MITZANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DO6785
Authorized Official - Phone:786-564-2439
Mailing Address - Street 1:15470 NW 77TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5823
Mailing Address - Country:US
Mailing Address - Phone:786-564-2439
Mailing Address - Fax:
Practice Address - Street 1:15470 NW 77TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5823
Practice Address - Country:US
Practice Address - Phone:786-564-2439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Multi-Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty