1619163540 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 1619163540 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:
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:
1619163540
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 DOUGLAS ROAD
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:
33134-3128
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:
9980 CENTRAL PARK BLVD N
Provider Second Line Business Practice Location Address:
SUITE 126
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33428-1762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-487-6600
Provider Business Practice Location Address Fax Number:
561-487-6633
Provider Enumeration Date:
09/25/2007

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , 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)





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