Provider Demographics
NPI:1336351543
Name:CUKIERMAN, AMIR (OD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:
Last Name:CUKIERMAN
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 1:7401 BRISTOL LN
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-1688
Mailing Address - Country:US
Mailing Address - Phone:954-340-6484
Mailing Address - Fax:
Practice Address - Street 1:2873 STIRLING RD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6516
Practice Address - Country:US
Practice Address - Phone:954-983-4969
Practice Address - Fax:954-983-1770
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2861152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620607700Medicaid
FL620607701Medicaid
FL620607701Medicaid
FL620607700Medicaid