Provider Demographics
NPI:1528124112
Name:BARATZ, MITCHELL GLENN (LDO)
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:GLENN
Last Name:BARATZ
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 NW 122ND TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1967
Mailing Address - Country:US
Mailing Address - Phone:954-431-1818
Mailing Address - Fax:954-441-2525
Practice Address - Street 1:1770 NW 122ND TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-1967
Practice Address - Country:US
Practice Address - Phone:954-431-1818
Practice Address - Fax:954-441-2525
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO1692156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0447270001Medicare ID - Type Unspecified