Provider Demographics
NPI:1194824789
Name:ATLAS, STEVE FORREST (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:FORREST
Last Name:ATLAS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8128 W BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2012
Mailing Address - Country:US
Mailing Address - Phone:954-475-1611
Mailing Address - Fax:954-475-7704
Practice Address - Street 1:8128 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2012
Practice Address - Country:US
Practice Address - Phone:954-475-1611
Practice Address - Fax:954-475-7704
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1521152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078131200Medicaid
FL19805Medicare ID - Type Unspecified
FLT93871Medicare UPIN