Provider Demographics
NPI:1780726877
Name:PEDIATRIC OPHTHALMOLOGY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:PEDIATRIC OPHTHALMOLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:561-832-3774
Mailing Address - Street 1:1500 N DIXIE HWY
Mailing Address - Street 2:#200
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2712
Mailing Address - Country:US
Mailing Address - Phone:561-832-3774
Mailing Address - Fax:561-832-4082
Practice Address - Street 1:1500 N DIXIE HWY
Practice Address - Street 2:#200
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2712
Practice Address - Country:US
Practice Address - Phone:561-832-3774
Practice Address - Fax:561-832-4082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55034207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3739927001OtherCIGNA
FL09187OtherBLUE CROSS BLUE SHIELD
FL09187OtherBLUE CROSS BLUE SHIELD
FL3739927001OtherCIGNA