Provider Demographics
NPI:1154666303
Name:OPHTHALMOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:OPHTHALMOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKHATTABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-578-2066
Mailing Address - Street 1:8399 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7311
Mailing Address - Country:US
Mailing Address - Phone:954-578-2066
Mailing Address - Fax:954-578-2595
Practice Address - Street 1:8399 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7311
Practice Address - Country:US
Practice Address - Phone:954-578-2066
Practice Address - Fax:954-578-2595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32083332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
6713670001Medicare PIN