Provider Demographics
NPI:1235638008
Name:EYE & EAR OF PALM BEACH GARDENS, LLC
Entity Type:Organization
Organization Name:EYE & EAR OF PALM BEACH GARDENS, LLC
Other - Org Name:GARDENS EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OD
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRANKEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-964-1333
Mailing Address - Street 1:9123 N MILITARY TRAIL
Mailing Address - Street 2:101
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-5990
Mailing Address - Country:US
Mailing Address - Phone:561-622-8200
Mailing Address - Fax:561-622-8308
Practice Address - Street 1:9123 N MILITARY TRAIL
Practice Address - Street 2:101
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-5990
Practice Address - Country:US
Practice Address - Phone:561-622-8200
Practice Address - Fax:561-622-8308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3338152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL3338OtherOD LIC#