Provider Demographics
NPI:1063670636
Name:COMPREHENSIVE EYE CARE OF SOUTH FLORIDA INC
Entity Type:Organization
Organization Name:COMPREHENSIVE EYE CARE OF SOUTH FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-558-8630
Mailing Address - Street 1:7480 FAIRWAY DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6879
Mailing Address - Country:US
Mailing Address - Phone:305-558-8630
Mailing Address - Fax:
Practice Address - Street 1:7480 FAIRWAY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6879
Practice Address - Country:US
Practice Address - Phone:305-558-8630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2941152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGQ938AMedicare PIN