Provider Demographics
NPI:1467496562
Name:CORAL SPRINGS OPHTHALMOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:CORAL SPRINGS OPHTHALMOLOGY ASSOCIATES PA
Other - Org Name:CORAL SPRINGS EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-752-6465
Mailing Address - Street 1:7886 WEST SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4710
Mailing Address - Country:US
Mailing Address - Phone:954-752-6465
Mailing Address - Fax:954-752-6591
Practice Address - Street 1:7886 WEST SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4710
Practice Address - Country:US
Practice Address - Phone:954-752-6465
Practice Address - Fax:954-752-6591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D63242Medicare UPIN
FL40775Medicare PIN
1138610001Medicare NSC