Provider Demographics
NPI: | 1700461183 |
---|---|
Name: | SYN-OPTIC EYE CARE |
Entity Type: | Organization |
Organization Name: | SYN-OPTIC EYE CARE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OPTOMETRIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | RANDA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DJABRI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OD |
Authorized Official - Phone: | 954-515-9924 |
Mailing Address - Street 1: | 2206 SW 16TH TER |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT LAUDERDALE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33315-1600 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 954-515-9924 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3320 NE 34TH ST |
Practice Address - Street 2: | |
Practice Address - City: | FORT LAUDERDALE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33308-6906 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-515-9924 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-03-16 |
Last Update Date: | 2021-03-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 1699399386 | Other | INDIVIDUAL NPI |