Provider Demographics
NPI:1265627814
Name:KORMAN, J. LOUIS (OD)
Entity type:Individual
Prefix:
First Name:J.
Middle Name:LOUIS
Last Name:KORMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11891 ROYAL PALM BLVD
Mailing Address - Street 2:APT. 203
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-7374
Mailing Address - Country:US
Mailing Address - Phone:954-344-8127
Mailing Address - Fax:
Practice Address - Street 1:12055 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4112
Practice Address - Country:US
Practice Address - Phone:954-392-5450
Practice Address - Fax:954-431-0745
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2537152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL939468OtherEYEMED