Provider Demographics
NPI:1467014902
Name:WESTON EYE CARE CENTER, LLC
Entity Type:Organization
Organization Name:WESTON EYE CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ-GOVIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-275-1437
Mailing Address - Street 1:10521 MARIN RANCHES DR
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-6301
Mailing Address - Country:US
Mailing Address - Phone:954-275-1437
Mailing Address - Fax:
Practice Address - Street 1:4577 WESTON RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3141
Practice Address - Country:US
Practice Address - Phone:954-217-5070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty