Provider Demographics
NPI:1285892992
Name:DOUGLAS J. MACHIELA O.D.P.A.
Entity type:Organization
Organization Name:DOUGLAS J. MACHIELA O.D.P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MACHIELA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-439-0075
Mailing Address - Street 1:5493 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-2056
Mailing Address - Country:US
Mailing Address - Phone:561-439-0075
Mailing Address - Fax:561-439-0413
Practice Address - Street 1:5493 10TH AVE N
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-2056
Practice Address - Country:US
Practice Address - Phone:561-439-0075
Practice Address - Fax:561-439-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2245332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078761200Medicaid
FL078761200Medicaid
FL0673880001Medicare PIN