Basic Information
| Provider Information | |||||||||
| NPI: | 1548354137 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAROLD M FORREST OD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10022 NW 20 STREET | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543465172 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11865 SW 26TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331752400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055529100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 01/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | FORREST | ||||||||
| AuthorizedOfficialFirstName: | HAROLD | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9543465172 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.