Provider Demographics
NPI:1306156526
Name:STALLION OPTICAL, LLC
Entity type:Organization
Organization Name:STALLION OPTICAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-964-2020
Mailing Address - Street 1:14201 SW 142 STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186
Mailing Address - Country:US
Mailing Address - Phone:305-964-2020
Mailing Address - Fax:786-242-4273
Practice Address - Street 1:9549 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2371
Practice Address - Country:US
Practice Address - Phone:305-591-6566
Practice Address - Fax:786-462-2352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service