Healthcare Provider Details

I. General information

NPI: 1245611730
Provider Name (Legal Business Name): AHAVA OPPENHEIMER OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7263 W ATLANTIC AVE
DELRAY BEACH FL
33446-1305
US

IV. Provider business mailing address

22360 GUADELOUPE ST
BOCA RATON FL
33433-4939
US

V. Phone/Fax

Practice location:
  • Phone: 561-496-2020
  • Fax:
Mailing address:
  • Phone: 917-406-8264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC3820
License Number StateFL

VIII. Authorized Official

Name: DR. AHAVA OPPENHEIMER
Title or Position: CEO
Credential: O.D.
Phone: 917-406-8264