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Individual

DR. JUAN R CANIZALES

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
12731 NEW BRITTANY BLVD, FORT MYERS, FL 33907-3632
(239) 418-0999
(239) 274-0773
Mailing address
330 BILLINGSLEY RD STE 205, CHARLOTTE, NC 28211-5020
(704) 366-0223
(704) 366-5327

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2129
NC
152W00000X
Optometrist
740
HI
152W00000X
Optometrist
OPC4007
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00369116
RAIL ROAD MEDICARE
FL
Enumeration date
10/20/2005
Last updated
07/22/2013
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