Provider Demographics
NPI:1114043536
Name:MARGOLESKY, PHILIP RONALD (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:RONALD
Last Name:MARGOLESKY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 SW 138TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-6681
Mailing Address - Country:US
Mailing Address - Phone:305-255-6614
Mailing Address - Fax:
Practice Address - Street 1:7437 N KENDALL DR
Practice Address - Street 2:SUITE B
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7702
Practice Address - Country:US
Practice Address - Phone:305-665-1044
Practice Address - Fax:305-665-6895
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC000833152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU32126Medicare UPIN
FL0667520001Medicare ID - Type Unspecified