Provider Demographics
NPI:1114110426
Name:TOWNSHIP EYE ASSOCIATES OF COCONUT CREEK., P.A.
Entity Type:Organization
Organization Name:TOWNSHIP EYE ASSOCIATES OF COCONUT CREEK., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-782-9330
Mailing Address - Street 1:4400 W SAMPLE RD
Mailing Address - Street 2:SUITE 154
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3470
Mailing Address - Country:US
Mailing Address - Phone:954-782-9330
Mailing Address - Fax:954-977-7401
Practice Address - Street 1:4400 W SAMPLE RD
Practice Address - Street 2:SUITE 154
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3470
Practice Address - Country:US
Practice Address - Phone:954-782-9330
Practice Address - Fax:954-977-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62339207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17819VMedicare PIN
FL21755Medicare PIN
FLF35694Medicare UPIN