Basic Information
| Provider Information | |||||||||
| NPI: | 1467458281 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYE CARE AND SURGERY CENTER OF FT. LAUDERDALE, LLC | ||||||||
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| OtherOrganizationName: | EYE CARE AND SURGERY CENTER OF FT. LAUDERDALE | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1097 S. LE JEINE ROAD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331342616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054422020 | ||||||||
| FaxNumber: | 3054427354 | ||||||||
| Practice Location | |||||||||
| Address1: | 2540 NE 9TH ST | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333043525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054422020 | ||||||||
| FaxNumber: | 3054427354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 03/16/2011 | ||||||||
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| AuthorizedOfficialLastName: | ARAN | ||||||||
| AuthorizedOfficialFirstName: | ALBERTO | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3054422020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 1004 | FL | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 261Q00000X | 1004 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 075949000 | 05 | FL | MEDICAID |