Provider Demographics
NPI:1043416704
Name:EYE SURGEONS & CONSULTANTS PA
Entity Type:Organization
Organization Name:EYE SURGEONS & CONSULTANTS PA
Other - Org Name:EMERALD EYES OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DELAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-894-1500
Mailing Address - Street 1:4651 SHERIDAN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3457
Mailing Address - Country:US
Mailing Address - Phone:954-894-1500
Mailing Address - Fax:954-894-1526
Practice Address - Street 1:4651 SHERIDAN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3457
Practice Address - Country:US
Practice Address - Phone:954-894-1500
Practice Address - Fax:954-894-1526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47764332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5837130001Medicare ID - Type Unspecified