Provider Demographics
NPI:1558475400
Name:FORT LAUDERDALE EYE INSTITUTE
Entity Type:Organization
Organization Name:FORT LAUDERDALE EYE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOLNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-741-5555
Mailing Address - Street 1:PO BOX 39209
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339-9209
Mailing Address - Country:US
Mailing Address - Phone:954-741-5555
Mailing Address - Fax:954-572-9658
Practice Address - Street 1:850 S PINE ISLAND RD
Practice Address - Street 2:SUITE A100
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3118
Practice Address - Country:US
Practice Address - Phone:954-741-5555
Practice Address - Fax:954-572-9658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
FL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
40276OtherBLUE CROSS BLUE SHEILD
FL250805200Medicaid
FL250805200Medicaid