Healthcare Provider Details

I. General information

NPI: 1346294113
Provider Name (Legal Business Name): SOUTH FLORIDA LASER EYE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 W SUNRISE BLVD
PLANTATION FL
33322-4103
US

IV. Provider business mailing address

8051 W SUNRISE BLVD
PLANTATION FL
33322-4103
US

V. Phone/Fax

Practice location:
  • Phone: 954-474-2900
  • Fax: 954-474-2901
Mailing address:
  • Phone: 954-474-2900
  • Fax: 954-474-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOS0006626
License Number StateFL

VIII. Authorized Official

Name: DR. HASSAN TAVAKKOLI
Title or Position: CEO
Credential: D.O.
Phone: 954-474-2900