1467458281 NPI number — EYE CARE AND SURGERY CENTER OF FT. LAUDERDALE, LLC

Table of content: (NPI 1467458281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467458281 NPI number — EYE CARE AND SURGERY CENTER OF FT. LAUDERDALE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE CARE AND SURGERY CENTER OF FT. LAUDERDALE, 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:
EYE CARE AND SURGERY CENTER OF FT. LAUDERDALE
Provider Other Organization Name Type Code:
4
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:
1467458281
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1097 S. LE JEINE ROAD
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
CORAL GABLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33134-2616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-442-2020
Provider Business Mailing Address Fax Number:
305-442-7354

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2540 NE 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33304-3525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-442-2020
Provider Business Practice Location Address Fax Number:
305-442-7354
Provider Enumeration Date:
06/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ARAN
Authorized Official First Name:
ALBERTO
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
305-442-2020

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  1004 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QA1903X , with the licence number: 1004 , 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: 075949000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106480200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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