1235988734 NPI number — 2010 OPTICAL PLUS

Table of content: DR. SAM EMERSON RAJIAH M.D. (NPI 1427052976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235988734 NPI number — 2010 OPTICAL PLUS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
2010 OPTICAL PLUS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235988734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5645 NW 87TH AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33178-2182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-373-6025
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5645 NW 87TH AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33178-2182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-373-6025
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2024

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
ENRIQUE
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTICIAN
Authorized Official Telephone Number:
786-373-6025

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 63014900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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