Provider Demographics
NPI:1427384239
Name:ADVANCED VISION CARE OF JUPITER INC
Entity Type:Organization
Organization Name:ADVANCED VISION CARE OF JUPITER INC
Other - Org Name:ADVANCED VISION CARE OF JUPITER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:P
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:CUKIERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-850-1454
Mailing Address - Street 1:1200 TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5256
Mailing Address - Country:US
Mailing Address - Phone:561-429-8753
Mailing Address - Fax:561-630-7066
Practice Address - Street 1:3893 MILITARY TRL STE 4
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2936
Practice Address - Country:US
Practice Address - Phone:561-429-8753
Practice Address - Fax:561-630-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZFL2861152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620607700Medicaid