Provider Demographics
NPI:1912113226
Name:CEO CENTER FOR EXECUTIVE OPHTHALMOLOGY
Entity Type:Organization
Organization Name:CEO CENTER FOR EXECUTIVE OPHTHALMOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:H
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-666-2365
Mailing Address - Street 1:PO BOX 566120
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33256-6120
Mailing Address - Country:US
Mailing Address - Phone:305-666-2365
Mailing Address - Fax:305-595-6352
Practice Address - Street 1:6233 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4022
Practice Address - Country:US
Practice Address - Phone:954-721-0000
Practice Address - Fax:954-721-6308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3738AMedicare PIN