Provider Demographics
NPI:1164165296
Name:INSTITUTE OF DERMATOLOGY & OCULOPLASTIC SURGERY PLLC
Entity Type:Organization
Organization Name:INSTITUTE OF DERMATOLOGY & OCULOPLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-499-0199
Mailing Address - Street 1:PO BOX 15853
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-1853
Mailing Address - Country:US
Mailing Address - Phone:941-499-0199
Mailing Address - Fax:941-200-4021
Practice Address - Street 1:1617 S TUTTLE AVE FL 3
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3132
Practice Address - Country:US
Practice Address - Phone:941-499-0199
Practice Address - Fax:941-200-4021
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INSTITUTE OF DERMATOLOGY & OCULOPLASTIC SURGERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-17
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncologyGroup - Multi-Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Multi-Specialty