Basic Information
| Provider Information | |||||||||
| NPI: | 1831361690 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IYER | ||||||||
| FirstName: | SIVA | ||||||||
| MiddleName: | SUBRAMANIAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100284 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522738778 | ||||||||
| FaxNumber: | 3522737402 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 SW ARCHER RD | ||||||||
| Address2: | #100371 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326103001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522650301 | ||||||||
| FaxNumber: | 3522650627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2008 | ||||||||
| LastUpdateDate: | 06/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 22805 | MS | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | MD205040 | LA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | ME127344 | FL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | P01454869 | 01 | MS | RAILROAD MEDICARE PTAN | OTHER | 017081100 | 05 | FL | MEDICAID | 04989542 | 05 | MS | MEDICAID |