Provider Demographics
NPI:1093198350
Name:RIVERSIDE EYE CENTER PLLC
Entity Type:Organization
Organization Name:RIVERSIDE EYE CENTER PLLC
Other - Org Name:RIVERSIDE EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINWAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-589-6625
Mailing Address - Street 1:14410 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3237
Mailing Address - Country:US
Mailing Address - Phone:772-589-8911
Mailing Address - Fax:772-589-7561
Practice Address - Street 1:14410 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3237
Practice Address - Country:US
Practice Address - Phone:772-589-8911
Practice Address - Fax:772-589-7561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
FLME77798207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty