1689898868 NPI number — RETINA ASSOCIATES OF CORAL SPRINGS, P.A.

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 1689898868 NPI number — RETINA ASSOCIATES OF CORAL SPRINGS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RETINA ASSOCIATES OF CORAL SPRINGS, P.A.
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:
1689898868
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1881 N UNIVERSITY DR
Provider Second Line Business Mailing Address:
SUITE 112
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33071-8915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-755-4633
Provider Business Mailing Address Fax Number:
954-755-4637

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1881 N UNIVERSITY DR
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33071-8915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-755-4633
Provider Business Practice Location Address Fax Number:
954-755-4637
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BYNOE
Authorized Official First Name:
LEON
Authorized Official Middle Name:
ALBERT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-755-4633

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  0600049327 , 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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