Provider Demographics
NPI: | 1770658940 |
---|---|
Name: | AMSTER, DEBORAH MICHELLE (OD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | DEBORAH |
Middle Name: | MICHELLE |
Last Name: | AMSTER |
Suffix: | |
Gender: | F |
Credentials: | OD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1919 VAN BUREN ST |
Mailing Address - Street 2: | APT. #816 |
Mailing Address - City: | HOLLYWOOD |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33020-7810 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 954-262-1402 |
Mailing Address - Fax: | 954-262-1818 |
Practice Address - Street 1: | 3200 S UNIVERSITY DR |
Practice Address - Street 2: | NSU THE EYE INSTITUTE SUITE 1402 |
Practice Address - City: | DAVIE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33328-2018 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-262-1402 |
Practice Address - Fax: | 954-262-1818 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-11-22 |
Last Update Date: | 2017-03-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | OPC3678 | 152WP0200X |
FL | OPC 3678 | 152W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | |
No | 152WP0200X | Eye and Vision Services Providers | Optometrist | Pediatrics |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 019641200 | Medicaid | |
FL | U92763 | Medicare UPIN |