Basic Information
Provider Information | |||||||||
NPI: | 1396179594 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RAMGOLAM-SINGH | ||||||||
FirstName: | ANIEKA | ||||||||
MiddleName: | DEANNA | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | O.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6233 N UNIVERSITY DR | ||||||||
Address2: |   | ||||||||
City: | TAMARAC | ||||||||
State: | FL | ||||||||
PostalCode: | 333214022 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9547210000 | ||||||||
FaxNumber: | 9547216308 | ||||||||
Practice Location | |||||||||
Address1: | 6233 N UNIVERSITY DR | ||||||||
Address2: |   | ||||||||
City: | TAMARAC | ||||||||
State: | FL | ||||||||
PostalCode: | 333214022 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9547210000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/25/2013 | ||||||||
LastUpdateDate: | 05/21/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/21/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPC4818 | FL | Y |   | Eye and Vision Services Providers | Optometrist |   |
ID Information
ID | Type | State | Issuer | Description | 00046704 | 01 | FL | SUPERIOR VISION | OTHER | 102430100 | 05 | FL |   | MEDICAID |