1275634800 NPI number — DR. OSCAR H CORREDOR O.D., F.A.A.O.

Table of content: DR. OSCAR H CORREDOR O.D., F.A.A.O. (NPI 1275634800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275634800 NPI number — DR. OSCAR H CORREDOR O.D., F.A.A.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORREDOR
Provider First Name:
OSCAR
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D., F.A.A.O.
Provider Gender Code:
M

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:
1275634800
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 PALAFOX PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32502-5629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-434-2060
Provider Business Mailing Address Fax Number:
850-429-8215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 PALAFOX PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-434-2060
Provider Business Practice Location Address Fax Number:
850-429-8215
Provider Enumeration Date:
09/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2003027013 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 002444 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: OPC5727 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 103846800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: OPC5727 . This is a "STATE LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 103846800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".