Provider Demographics
NPI:1760508212
Name:PALM VISION CENTER, INC.
Entity Type:Organization
Organization Name:PALM VISION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANHALT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-680-9334
Mailing Address - Street 1:10064 GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3309
Mailing Address - Country:US
Mailing Address - Phone:954-680-9334
Mailing Address - Fax:954-680-9985
Practice Address - Street 1:10064 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-3309
Practice Address - Country:US
Practice Address - Phone:954-680-9334
Practice Address - Fax:954-680-9985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2160152WC0802X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT77519Medicare UPIN
FLEE109AMedicare PIN