Provider Demographics
NPI:1619163540
Name:SOUTH FLORIDA EYE ASSOCIATES, PA
Entity Type:Organization
Organization Name:SOUTH FLORIDA EYE ASSOCIATES, PA
Other - Org Name:WEST BOCA EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PROFESSIONAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-461-0212
Mailing Address - Street 1:800 DOUGLAS ROAD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3128
Mailing Address - Country:US
Mailing Address - Phone:305-461-0212
Mailing Address - Fax:305-461-0208
Practice Address - Street 1:9980 CENTRAL PARK BLVD N
Practice Address - Street 2:SUITE 126
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1762
Practice Address - Country:US
Practice Address - Phone:561-487-6600
Practice Address - Fax:561-487-6633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77458Medicare PIN