Basic Information
| Provider Information | |||||||||
| NPI: | 1215067954 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CEO CENTER FOR EXECUTIVE OPHTHALMOLOGY LLC | ||||||||
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| OtherOrganizationName: | CEO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 566120 | ||||||||
| Address2: | |||||||||
| City: | PINECREST | ||||||||
| State: | FL | ||||||||
| PostalCode: | 332566120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056662365 | ||||||||
| FaxNumber: | 3052793988 | ||||||||
| Practice Location | |||||||||
| Address1: | 10260 SW 56TH ST | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331657015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056662365 | ||||||||
| FaxNumber: | 3055956352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 12/06/2012 | ||||||||
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| AuthorizedOfficialLastName: | RIVERA | ||||||||
| AuthorizedOfficialFirstName: | ALFRED | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3056662365 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.