Provider Demographics
NPI:1750586491
Name:CORAL SPRINGS EYE CENTER CHARTERED
Entity type:Organization
Organization Name:CORAL SPRINGS EYE CENTER CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:KOGANOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-972-6934
Mailing Address - Street 1:101 N STATE ROAD 7
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-4500
Mailing Address - Country:US
Mailing Address - Phone:954-972-6934
Mailing Address - Fax:954-972-6946
Practice Address - Street 1:101 N STATE ROAD 7
Practice Address - Street 2:SUITE 103
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-4500
Practice Address - Country:US
Practice Address - Phone:954-972-6934
Practice Address - Fax:954-972-6946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLOPC1231152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19074AMedicare ID - Type Unspecified