Provider Demographics
NPI:1821271131
Name:MARC A LURIE O D P A
Entity Type:Organization
Organization Name:MARC A LURIE O D P A
Other - Org Name:DR MARC A LURIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:LURIE
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:954-472-7070
Mailing Address - Street 1:8259 SUNSET STRIP
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-3058
Mailing Address - Country:US
Mailing Address - Phone:954-572-8524
Mailing Address - Fax:954-572-8923
Practice Address - Street 1:8259 SUNSET STRIP
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-3058
Practice Address - Country:US
Practice Address - Phone:954-572-8524
Practice Address - Fax:954-572-8923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1237332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0538760001Medicare NSC