Healthcare Provider Details

I. General information

NPI: 1336698315
Provider Name (Legal Business Name): DR. STEVEN E. WIGDOR, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2016
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17941 BISCAYNE BLVD
AVENTURA FL
33160-2502
US

IV. Provider business mailing address

17941 BISCAYNE BLVD
AVENTURA FL
33160-2502
US

V. Phone/Fax

Practice location:
  • Phone: 305-931-0225
  • Fax: 305-931-0238
Mailing address:
  • Phone: 305-931-0225
  • Fax: 305-931-0238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC1791
License Number StateFL

VIII. Authorized Official

Name: DR. STEVEN E WIGDOR
Title or Position: OPTOMETRIST
Credential: OD
Phone: 305-931-0225