Provider Demographics
NPI:1629388558
Name:GLAUCOMA SPECIALISTS OF SOUTH FLORIDA PA
Entity Type:Organization
Organization Name:GLAUCOMA SPECIALISTS OF SOUTH FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TALYA
Authorized Official - Middle Name:HOROWITZ
Authorized Official - Last Name:KUPIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-479-3884
Mailing Address - Street 1:6298 LINTON BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6444
Mailing Address - Country:US
Mailing Address - Phone:561-479-3884
Mailing Address - Fax:561-479-3885
Practice Address - Street 1:6298 LINTON BLVD STE 102
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6444
Practice Address - Country:US
Practice Address - Phone:561-479-3884
Practice Address - Fax:561-479-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79238207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1629388558OtherGR NPI
FL1548332497OtherNPI
FL1629388558OtherGROUP NPI
FLF57421OtherUPIN
FL49386Medicare PIN