Provider Demographics
NPI:1740387968
Name:OPHTHALMIC PARTNERS OF FLORIDA PA
Entity Type:Organization
Organization Name:OPHTHALMIC PARTNERS OF FLORIDA PA
Other - Org Name:CENTRAL FLORIDA RETINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUVPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-425-7188
Mailing Address - Street 1:3824 OAKWATER CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6263
Mailing Address - Country:US
Mailing Address - Phone:407-425-7188
Mailing Address - Fax:074-239-0404
Practice Address - Street 1:3824 OAKWATER CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6263
Practice Address - Country:US
Practice Address - Phone:407-425-7188
Practice Address - Fax:407-210-6478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21111OtherBCBS
FL252486400Medicaid
FLCD5041Medicare PIN
FL252486400Medicaid