Provider Demographics
NPI:1962799684
Name:ISEE EYECARE, INC.
Entity type:Organization
Organization Name:ISEE EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SMITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANC
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:786-897-9472
Mailing Address - Street 1:10860 NW 37TH CT
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-2701
Mailing Address - Country:US
Mailing Address - Phone:786-897-9472
Mailing Address - Fax:305-474-8071
Practice Address - Street 1:18610 NW 67TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2406
Practice Address - Country:US
Practice Address - Phone:305-474-0463
Practice Address - Fax:305-474-8071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4425152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001597300Medicaid