Provider Demographics
NPI:1942265368
Name:EYE ASSOCIATES OF PLANTATION INC
Entity Type:Organization
Organization Name:EYE ASSOCIATES OF PLANTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORDIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-792-6411
Mailing Address - Street 1:499 NW 70 AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-7572
Mailing Address - Country:US
Mailing Address - Phone:954-792-6411
Mailing Address - Fax:954-792-4460
Practice Address - Street 1:499 NW 70 AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317
Practice Address - Country:US
Practice Address - Phone:954-792-6411
Practice Address - Fax:954-792-4460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL100542207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34376OtherBLUE CROSS BLUE SHIELD
FL97847BMedicare ID - Type Unspecified