Provider Demographics
NPI:1275949653
Name:SOUTH FLORIDA VISION ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SOUTH FLORIDA VISION ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:COPPOLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-917-2337
Mailing Address - Street 1:2900 W CYPRESS CREEK RD STE 4
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1715
Mailing Address - Country:US
Mailing Address - Phone:954-917-2337
Mailing Address - Fax:954-917-2962
Practice Address - Street 1:2900 W CYPRESS CREEK RD STE 4
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1715
Practice Address - Country:US
Practice Address - Phone:954-917-2337
Practice Address - Fax:954-917-2962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1910207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty