Provider Demographics
NPI:1821374265
Name:ELITE EYE CARE OF SOUTH FLORIDA, P.A.
Entity Type:Organization
Organization Name:ELITE EYE CARE OF SOUTH FLORIDA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-717-9995
Mailing Address - Street 1:8025 NW 36TH ST
Mailing Address - Street 2:#300
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6625
Mailing Address - Country:US
Mailing Address - Phone:305-717-9995
Mailing Address - Fax:
Practice Address - Street 1:8025 NW 36TH ST
Practice Address - Street 2:#300
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6625
Practice Address - Country:US
Practice Address - Phone:305-717-9995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2941152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty