Provider Demographics
NPI:1821080771
Name:POLACK, PETER J (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:POLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1500 SE MAGNOLIA EXT STE 101
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4452
Mailing Address - Country:US
Mailing Address - Phone:352-622-5183
Mailing Address - Fax:352-622-1348
Practice Address - Street 1:4414 SW COLLEGE RD STE 1462
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4790
Practice Address - Country:US
Practice Address - Phone:352-622-5183
Practice Address - Fax:352-629-5026
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOPC4899207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10441OtherBC/BS PROVIDER NUMBER
FL063494800Medicaid
E61430Medicare UPIN
FL10441ZMedicare PIN