Healthcare Provider Details

I. General information

NPI: 1659706588
Provider Name (Legal Business Name): AUSTIN BACH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 SHERIDAN ST STE 102B
HOLLYWOOD FL
33021-1407
US

IV. Provider business mailing address

4330 SHERIDAN ST STE 102B
HOLLYWOOD FL
33021-1407
US

V. Phone/Fax

Practice location:
  • Phone: 954-287-2010
  • Fax: 305-723-1910
Mailing address:
  • Phone: 954-287-2010
  • Fax: 305-723-1910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOS14416
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License NumberOS14416
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: