Provider Demographics
NPI:1083616155
Name:BUCK, PAULINE KOLKER (OD)
Entity Type:Individual
Prefix:DR
First Name:PAULINE
Middle Name:KOLKER
Last Name:BUCK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4770 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 550
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3202
Mailing Address - Country:US
Mailing Address - Phone:305-576-5338
Mailing Address - Fax:305-576-5366
Practice Address - Street 1:4770 BISCAYNE BLVD
Practice Address - Street 2:SUITE 550
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3202
Practice Address - Country:US
Practice Address - Phone:305-576-5338
Practice Address - Fax:305-576-5366
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2787152WP0200X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620110500Medicaid
FLU56106Medicare UPIN
FL20576Medicare ID - Type Unspecified