Provider Demographics
NPI:1295035640
Name:CUKIERMAN & KOEPNICK EYECARE, INC.
Entity Type:Organization
Organization Name:CUKIERMAN & KOEPNICK EYECARE, INC.
Other - Org Name:C & K EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:KOEPNICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-271-1364
Mailing Address - Street 1:11654 N KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1005
Mailing Address - Country:US
Mailing Address - Phone:305-271-1364
Mailing Address - Fax:305-596-4237
Practice Address - Street 1:11654 N KENDALL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1005
Practice Address - Country:US
Practice Address - Phone:305-271-1364
Practice Address - Fax:305-596-4237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2066152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620625500Medicaid
K2655OtherGROUP MEDICARE IDENTIFICATION NUMBER
20582ZOtherDR. KOEPNICK'S MEDICARE NUMBER
U852770001Medicare UPIN