Healthcare Provider Details

I. General information

NPI: 1821080771
Provider Name (Legal Business Name): PETER J. POLACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 SW COLLEGE RD STE 1462
OCALA FL
34474-4790
US

IV. Provider business mailing address

4414 SW COLLEGE RD UNIT 1462
OCALA FL
34474-2701
US

V. Phone/Fax

Practice location:
  • Phone: 352-622-5183
  • Fax: 352-629-5026
Mailing address:
  • Phone: 352-622-5183
  • Fax: 352-622-1348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License NumberOPC4899
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: