1972707859 NPI number — MIDTOWN EYE CARE, 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 1972707859 NPI number — MIDTOWN EYE CARE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDTOWN EYE CARE, 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:
1972707859
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
599 S FEDERAL HWY
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
DANIA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33004-4174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-927-2020
Provider Business Mailing Address Fax Number:
954-927-3418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
599 S FEDERAL HWY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
DANIA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33004-4174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-927-2020
Provider Business Practice Location Address Fax Number:
954-927-3418
Provider Enumeration Date:
06/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PELTZER
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-573-2090

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPC0002646 , 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: 620495300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 078929100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107779700 . 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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