Provider Demographics
NPI:1053202705
Name:SABATES, REINALDO (LICENSES DISPENSING)
Entity type:Individual
Prefix:
First Name:REINALDO
Middle Name:
Last Name:SABATES
Suffix:
Gender:X
Credentials:LICENSES DISPENSING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5130
Mailing Address - Country:US
Mailing Address - Phone:954-579-0062
Mailing Address - Fax:
Practice Address - Street 1:4150 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5130
Practice Address - Country:US
Practice Address - Phone:941-497-0960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3204156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician