Provider Demographics
NPI:1942475173
Name:DR STEVEN M TUCKER PA
Entity Type:Organization
Organization Name:DR STEVEN M TUCKER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-434-5500
Mailing Address - Street 1:9950 GRIFFIN ROAD
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3420
Mailing Address - Country:US
Mailing Address - Phone:954-434-5500
Mailing Address - Fax:954-434-5501
Practice Address - Street 1:9950 GRIFFIN ROAD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-3420
Practice Address - Country:US
Practice Address - Phone:954-434-5500
Practice Address - Fax:954-434-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1120152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084681300Medicaid
FL19942Medicare PIN
FLT84021Medicare UPIN
FL0938830001Medicare NSC