Provider Demographics
NPI:1265428239
Name:FLORES-GUERRA, JUDITH (OD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:FLORES-GUERRA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 566644
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33256-6644
Mailing Address - Country:US
Mailing Address - Phone:305-926-2991
Mailing Address - Fax:305-704-3856
Practice Address - Street 1:7800 SW 104TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2631
Practice Address - Country:US
Practice Address - Phone:305-595-9262
Practice Address - Fax:305-595-9724
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2948152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20629AMedicare PIN
FL20629AMedicare PIN