Provider Demographics
NPI:1972707859
Name:MIDTOWN EYE CARE, PA
Entity Type:Organization
Organization Name:MIDTOWN EYE CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PELTZER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-573-2090
Mailing Address - Street 1:599 S FEDERAL HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-4174
Mailing Address - Country:US
Mailing Address - Phone:954-927-2020
Mailing Address - Fax:954-927-3418
Practice Address - Street 1:599 S FEDERAL HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-4174
Practice Address - Country:US
Practice Address - Phone:954-927-2020
Practice Address - Fax:954-927-3418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC0002646152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620495300Medicaid
FL078929100Medicaid
FL620495300Medicaid
FLAG296AMedicare PIN
FLU38371Medicare UPIN
FLU38371Medicare UPIN