Provider Demographics
NPI:1235397803
Name:COMPREHENSIVE EYE CARE
Entity Type:Organization
Organization Name:COMPREHENSIVE EYE CARE
Other - Org Name:BEACON CENTER EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-717-9995
Mailing Address - Street 1:8025 NW 36TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6625
Mailing Address - Country:US
Mailing Address - Phone:305-717-9995
Mailing Address - Fax:
Practice Address - Street 1:8025 NW 36TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6625
Practice Address - Country:US
Practice Address - Phone:305-717-9995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE EYE CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2941302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization