Provider Demographics
NPI:1568471225
Name:ONLY FOR EYES
Entity type:Organization
Organization Name:ONLY FOR EYES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:A
Authorized Official - Last Name:REASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-456-7200
Mailing Address - Street 1:800 E HALLANDALE BEACH BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4475
Mailing Address - Country:US
Mailing Address - Phone:954-456-7200
Mailing Address - Fax:
Practice Address - Street 1:800 E HALLANDALE BEACH BLVD STE 9
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4475
Practice Address - Country:US
Practice Address - Phone:954-456-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDA 5767156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5758150001Medicare NSC