Provider Demographics
NPI:1427150721
Name:MED EYE OPTICAL LLC
Entity type:Organization
Organization Name:MED EYE OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-661-8588
Mailing Address - Street 1:5858 SW 68 ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3693
Mailing Address - Country:US
Mailing Address - Phone:305-661-8588
Mailing Address - Fax:305-661-4906
Practice Address - Street 1:5858 SW 68 ST
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3693
Practice Address - Country:US
Practice Address - Phone:305-661-8588
Practice Address - Fax:305-661-4906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0866849300Medicaid