Provider Demographics
NPI:1366984155
Name:CENTAURUS HEALTHCARE, INCORPORATED
Entity type:Organization
Organization Name:CENTAURUS HEALTHCARE, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:VICTOME
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-260-2154
Mailing Address - Street 1:6137 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3074
Mailing Address - Country:US
Mailing Address - Phone:561-357-1009
Mailing Address - Fax:
Practice Address - Street 1:7657 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2534
Practice Address - Country:US
Practice Address - Phone:561-357-1009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty