Provider Demographics
NPI:1336698315
Name:DR. STEVEN E. WIGDOR, P.A.
Entity Type:Organization
Organization Name:DR. STEVEN E. WIGDOR, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WIGDOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-931-0225
Mailing Address - Street 1:17941 BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2502
Mailing Address - Country:US
Mailing Address - Phone:305-931-0225
Mailing Address - Fax:305-931-0238
Practice Address - Street 1:17941 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-2502
Practice Address - Country:US
Practice Address - Phone:305-931-0225
Practice Address - Fax:305-931-0238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-01
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1791152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID