Provider Demographics
NPI:1063502458
Name:PGA EYE ASSOCIATES,LLC
Entity Type:Organization
Organization Name:PGA EYE ASSOCIATES,LLC
Other - Org Name:PGA EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIENNE
Authorized Official - Middle Name:LAURA
Authorized Official - Last Name:ROSENBUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-799-3930
Mailing Address - Street 1:6271 PGA BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-4034
Mailing Address - Country:US
Mailing Address - Phone:561-799-3930
Mailing Address - Fax:
Practice Address - Street 1:6271 PGA BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-4034
Practice Address - Country:US
Practice Address - Phone:561-799-3930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8584Medicare ID - Type Unspecified