Provider Demographics
NPI:1154478535
Name:FLAMINGO FALLS EYE CARE
Entity Type:Organization
Organization Name:FLAMINGO FALLS EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-433-1490
Mailing Address - Street 1:1770 NW 122ND TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1967
Mailing Address - Country:US
Mailing Address - Phone:954-433-1490
Mailing Address - Fax:954-433-0994
Practice Address - Street 1:1770 NW 122ND TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-1967
Practice Address - Country:US
Practice Address - Phone:954-433-1490
Practice Address - Fax:954-433-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1825152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1104811736OtherDR. WENZEL NPI
FL1821084179OtherDR. DAVIS NPI
FLK3063Medicare PIN
FL1104811736OtherDR. WENZEL NPI