Provider Demographics
NPI:1649311291
Name:OPHTHALMOLOGY ASSOCIATES, PA
Entity type:Organization
Organization Name:OPHTHALMOLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-578-2066
Mailing Address - Street 1:8395 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7301
Mailing Address - Country:US
Mailing Address - Phone:954-578-2066
Mailing Address - Fax:
Practice Address - Street 1:8395 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7301
Practice Address - Country:US
Practice Address - Phone:954-578-2066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0032083207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0993730002OtherMEDICARE DMERC
FL40668Medicare PIN
FL0993730002OtherMEDICARE DMERC