Healthcare Provider Details

I. General information

NPI: 1720717937
Provider Name (Legal Business Name): BH EYES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 07/26/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4322 HOLLYWOOD BLVD STE 120
HOLLYWOOD FL
33021-6639
US

IV. Provider business mailing address

8088 S SAVANNAH CIR
DAVIE FL
33328-3036
US

V. Phone/Fax

Practice location:
  • Phone: 954-962-9994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. SHIRLEY LEONI
Title or Position: OWNER
Credential: OD
Phone: 908-456-3665