Healthcare Provider Details

I. General information

NPI: 1538413232
Provider Name (Legal Business Name): OLENA MOISEIYKINA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR SANFORD ZIFF BUILDING 2ND FLOOR
DAVIE FL
33328-2018
US

IV. Provider business mailing address

3200 S UNIVERSITY DR TERRY BUILDING SUITE 1402
DAVIE FL
33328-2018
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-4200
  • Fax: 954-262-3217
Mailing address:
  • Phone: 954-262-1402
  • Fax: 954-262-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOFC59
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002707
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: