1609290279 NPI number — SOUTH FLORIDA EYE ASSOCIATES, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609290279 NPI number — SOUTH FLORIDA EYE ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH FLORIDA EYE ASSOCIATES, PA
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:
1609290279
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 S DOUGLAS RD
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
CORAL GABLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33134-3125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-461-0212
Provider Business Mailing Address Fax Number:
305-461-0208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5757 BLUE LAGOON DR
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33126-2058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-545-0800
Provider Business Practice Location Address Fax Number:
305-545-8817
Provider Enumeration Date:
02/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
V.P. PROFESSIONAL SERVICES
Authorized Official Telephone Number:
305-461-0212

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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