MEDICARE: EYE SURGEONS & CONSULTANTS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	ME47764	FL

General Provider Information

NPI Number	:	1043416704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE SURGEONS & CONSULTANTS PA

Provider Business Mailing Address
First Line	:	4651 SHERIDAN ST
Second Line	:	SUITE 100
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3457
Country	:	US
Telephone Number	:	954-894-1500
Fax Number	:	954-894-1526

Provider Business Practice Location Address
First Line	:	4651 SHERIDAN ST
Second Line	:	SUITE 100
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3457
Country	:	US
Telephone Number	:	954-894-1500
Fax Number	:	954-894-1526

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	DELAIN JOYCE
Credential	:
Telephone Number	:	954-894-1500

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	08/22/2020

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