Provider Demographics
NPI:1154689149
Name:MIDTOWN MIAMI EYE CENTER INC
Entity type:Organization
Organization Name:MIDTOWN MIAMI EYE CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALAHUDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-326-0423
Mailing Address - Street 1:3176 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3002
Mailing Address - Country:US
Mailing Address - Phone:954-431-2020
Mailing Address - Fax:954-435-7124
Practice Address - Street 1:3176 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025
Practice Address - Country:US
Practice Address - Phone:954-431-2020
Practice Address - Fax:954-435-7124
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDTOWN MIAMI EYE CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-26
Last Update Date:2018-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4347152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000659601Medicaid