Provider Demographics
NPI: | 1568723476 |
---|---|
Name: | INNA OZEROV MD PA |
Entity Type: | Organization |
Organization Name: | INNA OZEROV MD PA |
Other - Org Name: | MIAMI EYE INSTITUTE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | M.D. |
Authorized Official - Prefix: | |
Authorized Official - First Name: | INNA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | OZEROV |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 954-251-1802 |
Mailing Address - Street 1: | 7700 DAVIE ROAD EXT |
Mailing Address - Street 2: | |
Mailing Address - City: | HOLLYWOOD |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33024-2516 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 954-251-1802 |
Mailing Address - Fax: | 954-626-8145 |
Practice Address - Street 1: | 7700 DAVIE ROAD EXT |
Practice Address - Street 2: | |
Practice Address - City: | HOLLYWOOD |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33024-2516 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-251-1802 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-06-06 |
Last Update Date: | 2020-07-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME106275 | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist | Group - Single Specialty |