Provider Demographics
NPI:1285700252
Name:TIRADO, ALEJANDRO MIGUEL (OD, PA)
Entity type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:MIGUEL
Last Name:TIRADO
Suffix:
Gender:M
Credentials:OD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:13119 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-6150
Mailing Address - Country:US
Mailing Address - Phone:904-683-8444
Mailing Address - Fax:904-683-5148
Practice Address - Street 1:13119 PROFESSIONAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6150
Practice Address - Country:US
Practice Address - Phone:904-683-8444
Practice Address - Fax:904-683-5148
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC02566152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU24552Medicare UPIN
FL20303Medicare PIN