Provider Demographics
NPI:1700941002
Name:NORTH RIDGE EYE CENTER, P.A.
Entity Type:Organization
Organization Name:NORTH RIDGE EYE CENTER, P.A.
Other - Org Name:NORTH RIDGE EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ILEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-771-4271
Mailing Address - Street 1:5601 N DIXIE HWY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4148
Mailing Address - Country:US
Mailing Address - Phone:954-771-4271
Mailing Address - Fax:954-776-5959
Practice Address - Street 1:5601 N DIXIE HWY
Practice Address - Street 2:SUITE 115
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-4148
Practice Address - Country:US
Practice Address - Phone:954-771-4271
Practice Address - Fax:954-776-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57956207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0331Medicare PIN