Healthcare Provider Details

I. General information

NPI: 1609059054
Provider Name (Legal Business Name): RADZWILL OPTOMETRIC ASSOCIATES CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 E SUNRISE BLVD
FORT LAUDERDALE FL
33304-2500
US

IV. Provider business mailing address

2312 E SUNRISE BLVD
FORT LAUDERDALE FL
33304-2500
US

V. Phone/Fax

Practice location:
  • Phone: 954-563-3450
  • Fax: 954-563-8911
Mailing address:
  • Phone: 954-563-3450
  • Fax: 954-563-8911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number0003042
License Number StateFL

VIII. Authorized Official

Name: ERIC RADZWILL
Title or Position: PRESIDENT
Credential: O.D.
Phone: 954-563-3450