Provider Demographics
NPI:1609047620
Name:OPPENHEIMER EYE CLINIC, PA
Entity Type:Organization
Organization Name:OPPENHEIMER EYE CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OPPENHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-294-5503
Mailing Address - Street 1:1708 N ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-7299
Mailing Address - Country:US
Mailing Address - Phone:305-294-5503
Mailing Address - Fax:305-294-5509
Practice Address - Street 1:1708 N ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-7299
Practice Address - Country:US
Practice Address - Phone:305-294-5503
Practice Address - Fax:305-294-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP0000997152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084289300Medicaid
FLK2157Medicare PIN