Healthcare Provider Details

I. General information

NPI: 1679141238
Provider Name (Legal Business Name): IGLESIAS EYE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11641 KEW GARDENS AVE STE 209
PALM BEACH GARDENS FL
33410-2846
US

IV. Provider business mailing address

11641 KEW GARDENS AVE STE 209
PALM BEACH GARDENS FL
33410-2846
US

V. Phone/Fax

Practice location:
  • Phone: 561-331-3833
  • Fax: 561-331-3893
Mailing address:
  • Phone: 561-331-3833
  • Fax: 561-331-3893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. MELISSA IGLESIAS
Title or Position: PRESIDENT
Credential: DO
Phone: 561-331-3833