Healthcare Provider Details

I. General information

NPI: 1730630773
Provider Name (Legal Business Name): DR. STEVEN E. WIGDOR, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 N FEDERAL HWY
LIGHTHOUSE POINT FL
33064-6649
US

IV. Provider business mailing address

3650 N FEDERAL HWY
LIGHTHOUSE POINT FL
33064-6649
US

V. Phone/Fax

Practice location:
  • Phone: 954-943-6210
  • Fax: 954-943-5148
Mailing address:
  • Phone: 954-943-6210
  • Fax: 954-943-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC1791
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. STEVEN E WIGDOR
Title or Position: OPTOMETRIST
Credential: OD
Phone: 305-931-0225