Provider Demographics
NPI:1376554725
Name:ARENCIBIA, GUILLERMO (OD)
Entity type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:
Last Name:ARENCIBIA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13876 SW 56TH ST STE 335
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6021
Mailing Address - Country:US
Mailing Address - Phone:305-382-2424
Mailing Address - Fax:786-803-8709
Practice Address - Street 1:8150 SW 8TH ST STE 107
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4264
Practice Address - Country:US
Practice Address - Phone:305-382-2424
Practice Address - Fax:786-803-8709
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3686152WX0102X, 152WS0006X, 152WC0802X, 152WP0200X
FLOPC3686152W00000X, 152WC0802X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621008200Medicaid
FLFL3686OtherEYEMED
FL201861049OtherVISION CARE PLAN-VCP
FL2157OtherSUPERIOR
FL50887OtherDAVIS VISION
FLOE26777OtherSPECTERA
FL201861049OtherPRIMARY PLUS
FLAH384Medicare PIN