Provider Demographics
NPI:1467458281
Name:EYE CARE AND SURGERY CENTER OF FT. LAUDERDALE, LLC
Entity Type:Organization
Organization Name:EYE CARE AND SURGERY CENTER OF FT. LAUDERDALE, LLC
Other - Org Name:EYE CARE AND SURGERY CENTER OF FT. LAUDERDALE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-442-2020
Mailing Address - Street 1:1097 S. LE JEINE ROAD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2616
Mailing Address - Country:US
Mailing Address - Phone:305-442-2020
Mailing Address - Fax:305-442-7354
Practice Address - Street 1:2540 NE 9TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3525
Practice Address - Country:US
Practice Address - Phone:305-442-2020
Practice Address - Fax:305-442-7354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1004261Q00000X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075949000Medicaid
FL075949000Medicaid
F1050Medicare PIN