Provider Demographics
NPI:1144416637
Name:AT YOUR HOME EYECARE, PA
Entity Type:Organization
Organization Name:AT YOUR HOME EYECARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-536-8905
Mailing Address - Street 1:1856 N NOB HILL RD # 261
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6548
Mailing Address - Country:US
Mailing Address - Phone:954-536-8905
Mailing Address - Fax:954-370-4546
Practice Address - Street 1:21214 N SWEETWATER LN
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428
Practice Address - Country:US
Practice Address - Phone:954-536-8905
Practice Address - Fax:954-370-4546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3084152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620329900Medicaid
FL620329900Medicaid
FLU69593Medicare UPIN
FLK1857Medicare PIN