Healthcare Provider Details

I. General information

NPI: 1396382719
Provider Name (Legal Business Name): EYE SURGERY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S PARK RD STE 300
HOLLYWOOD FL
33021-8353
US

IV. Provider business mailing address

300 S PARK RD STE 300
HOLLYWOOD FL
33021-8353
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-2740
  • Fax: 954-923-8379
Mailing address:
  • Phone: 954-925-2740
  • Fax: 954-923-8379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE L NEAL
Title or Position: PRESIDENT
Credential:
Phone: 469-214-0144