Provider Demographics
NPI:1366296386
Name:POH DORAL LLC
Entity type:Organization
Organization Name:POH DORAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIDZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-649-4011
Mailing Address - Street 1:20815 NE 16TH AVE STE B15
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-2121
Mailing Address - Country:US
Mailing Address - Phone:305-649-4011
Mailing Address - Fax:305-649-4023
Practice Address - Street 1:10674 NW 19TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2542
Practice Address - Country:US
Practice Address - Phone:305-649-4011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty