Individual
FATEN EDRISKHALAF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
4302 ALTON RD STE 300, MIAMI BEACH, FL 33140
(305) 672-9989
(786) 245-2006
Mailing address
50 BISCAYNE BLVD, 3602, MIAMI, FL 33132-2905
(786) 452-6690
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC5216
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IU041U
MEDICARE
FL
Enumeration date
07/06/2016
Last updated
07/31/2018
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