Provider Demographics
NPI:1114072360
Name:OCULOPLASTIC AND ORBITAL CONSULTANTS PA
Entity Type:Organization
Organization Name:OCULOPLASTIC AND ORBITAL CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-845-6500
Mailing Address - Street 1:4060 PGA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6570
Mailing Address - Country:US
Mailing Address - Phone:561-845-6500
Mailing Address - Fax:561-845-6300
Practice Address - Street 1:4060 PGA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-845-6500
Practice Address - Fax:561-845-6300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
24744Medicare ID - Type Unspecified