1235638008 NPI number — EYE & EAR OF PALM BEACH GARDENS, LLC

Table of content: (NPI 1235638008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235638008 NPI number — EYE & EAR OF PALM BEACH GARDENS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE & EAR OF PALM BEACH GARDENS, LLC
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:
6
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:
1235638008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9123 N MILITARY TRAIL
Provider Second Line Business Mailing Address:
101
Provider Business Mailing Address City Name:
PALM BEACH GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33410-5990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-622-8200
Provider Business Mailing Address Fax Number:
561-622-8308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9123 N MILITARY TRAIL
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
PALM BEACH GARDENS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33410-5990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-622-8200
Provider Business Practice Location Address Fax Number:
561-622-8308
Provider Enumeration Date:
02/07/2018

Additional Information

Authorized Official

Authorized Official Last Name:
FRANKEL
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/OD
Authorized Official Telephone Number:
561-964-1333

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPC3338 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: FL3338 . This is a "OD LIC#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com