Provider Demographics
NPI:1962734137
Name:STEPHEN JEFFREY VENOKUR OD PA
Entity type:Organization
Organization Name:STEPHEN JEFFREY VENOKUR OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:VENOKUR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-757-1759
Mailing Address - Street 1:7901 BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-4618
Mailing Address - Country:US
Mailing Address - Phone:305-757-1759
Mailing Address - Fax:305-762-1600
Practice Address - Street 1:7901 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-4618
Practice Address - Country:US
Practice Address - Phone:305-757-1759
Practice Address - Fax:305-762-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1341152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicare PIN