Provider Demographics
NPI:1073542650
Name:SOUTH FLORIDA EYE INSTITUTE, INC.
Entity Type:Organization
Organization Name:SOUTH FLORIDA EYE INSTITUTE, INC.
Other - Org Name:JORGE CAMACHO MD INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRTHA
Authorized Official - Middle Name:AMELIA
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:954-529-1075
Mailing Address - Street 1:6233 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4022
Mailing Address - Country:US
Mailing Address - Phone:954-721-0000
Mailing Address - Fax:954-721-6308
Practice Address - Street 1:6233 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4022
Practice Address - Country:US
Practice Address - Phone:954-721-0000
Practice Address - Fax:954-721-6308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9904886OtherAETNA PIN
FL6104868OtherUHC
FL017975502Medicaid
FL002YBOtherBCBSF
FL017975500Medicaid
FLQMP000003668515OtherMOLINA
FL=========OtherHUMANA
FL=========OtherDAVIS VISION
FL=========OtherOPTICARE
FL=========OtherSPECTERA
FLQMP000003668515OtherMOLINA
FL017975500Medicaid
FL915OtherICARE
FL=========OtherCOVENTRY
FL=========OtherMEDICA & PREFERRED CARE PARTNERS