Provider Demographics
NPI:1598039000
Name:DR NICOLAS GILBERG OD PA
Entity Type:Organization
Organization Name:DR NICOLAS GILBERG OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:786-500-2020
Mailing Address - Street 1:13100 CORONADO DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2154
Mailing Address - Country:US
Mailing Address - Phone:786-500-2020
Mailing Address - Fax:
Practice Address - Street 1:14711 BISCAYNE BLVD STE 308
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-1213
Practice Address - Country:US
Practice Address - Phone:786-500-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGM341AMedicare PIN