Provider Demographics
NPI:1912032566
Name:SOUTH FLORIDA VISION SERVICES, INC.
Entity Type:Organization
Organization Name:SOUTH FLORIDA VISION SERVICES, INC.
Other - Org Name:SOUTH FLORIDA VISION CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:COPPOLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-726-5047
Mailing Address - Street 1:2900 W CYPRESS CREEK RD STE 4
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1715
Mailing Address - Country:US
Mailing Address - Phone:954-726-5047
Mailing Address - Fax:954-726-6372
Practice Address - Street 1:2900 W CYPRESS CREEK RD
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1715
Practice Address - Country:US
Practice Address - Phone:954-979-2191
Practice Address - Fax:954-979-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1910152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621006609Medicaid