Healthcare Provider Details

I. General information

NPI: 1881634541
Provider Name (Legal Business Name): MR. ALVIN STERN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8177 GLADES RD BAY 3
BOCA RATON FL
33434-4071
US

IV. Provider business mailing address

9722 COLORADO CT
BOCA RATON FL
33434-2719
US

V. Phone/Fax

Practice location:
  • Phone: 561-487-4300
  • Fax: 561-487-3835
Mailing address:
  • Phone: 561-487-4300
  • Fax: 561-487-3835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDO1774
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: