Provider Demographics
NPI:1649446097
Name:ISLAND CITY EYECARE LLC
Entity type:Organization
Organization Name:ISLAND CITY EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-764-6906
Mailing Address - Street 1:2301 WILTON DR
Mailing Address - Street 2:UNIT C1
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1202
Mailing Address - Country:US
Mailing Address - Phone:954-764-6906
Mailing Address - Fax:954-463-7933
Practice Address - Street 1:2301 WILTON DR
Practice Address - Street 2:UNIT C1
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1202
Practice Address - Country:US
Practice Address - Phone:954-764-6906
Practice Address - Fax:954-463-7933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001072152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078966600Medicaid
FL000J1OtherBCBS
FL084758500Medicaid
FL20512OtherBCBS
FL321773OtherAVMED
FL19523OtherBLUE CROSS BLUE SHIELD
FL3446264OtherAETNA
FL6374970001OtherDMERC CIGNA
FL220833OtherAVMED
FL621354500Medicaid
FL000J1OtherBCBS
FL6374970001OtherDMERC CIGNA
FL321773OtherAVMED
FL621354500Medicaid
FL3446264OtherAETNA
FL078966600Medicaid
FLDC131ZMedicare PIN