Provider Demographics
NPI:1932494762
Name:WINTER PARK OPHTHALMOLOGY PA
Entity Type:Organization
Organization Name:WINTER PARK OPHTHALMOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:KURZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-637-2033
Mailing Address - Street 1:266 DETMAR DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3914
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:320 EDINBURGH DR
Practice Address - Street 2:SUITE A
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4157
Practice Address - Country:US
Practice Address - Phone:407-637-2033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6619820001Medicare NSC