Provider Demographics
NPI:1750511747
Name:OPHTHALMOLOGY CONSULTING SERVICES
Entity Type:Organization
Organization Name:OPHTHALMOLOGY CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARIM
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-272-7500
Mailing Address - Street 1:2140 KINGSLEY AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5180
Mailing Address - Country:US
Mailing Address - Phone:904-272-7500
Mailing Address - Fax:904-272-7502
Practice Address - Street 1:2140 KINGSLEY AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5180
Practice Address - Country:US
Practice Address - Phone:904-272-7500
Practice Address - Fax:904-272-7502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL91598207R00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty