Provider Demographics
NPI:1215987292
Name:OPHTHALMOLOGY ASSOCIATES OF SOUTH FLORIDA PA
Entity type:Organization
Organization Name:OPHTHALMOLOGY ASSOCIATES OF SOUTH FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-575-4711
Mailing Address - Street 1:3100 CORAL HILLS DR
Mailing Address - Street 2:206
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4137
Mailing Address - Country:US
Mailing Address - Phone:954-575-4711
Mailing Address - Fax:954-575-4722
Practice Address - Street 1:3100 CORAL HILLS DR
Practice Address - Street 2:206
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4137
Practice Address - Country:US
Practice Address - Phone:954-575-4711
Practice Address - Fax:954-575-4722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8684207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7890361OtherAETNA
FL2896366OtherAETNA HMO
FL2896366OtherAETNA HMO
FLE7874AMedicare PIN