Provider Demographics
NPI:1114199205
Name:OPHTHALMOLOGY CONSULTANTS PA
Entity Type:Organization
Organization Name:OPHTHALMOLOGY CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-977-8770
Mailing Address - Street 1:5800 COLONIAL DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5682
Mailing Address - Country:US
Mailing Address - Phone:954-977-8770
Mailing Address - Fax:954-977-8774
Practice Address - Street 1:5800 COLONIAL DRIVE
Practice Address - Street 2:SUITE #100
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5682
Practice Address - Country:US
Practice Address - Phone:954-977-8770
Practice Address - Fax:954-977-8774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK047Medicare PIN