Healthcare Provider Details

I. General information

NPI: 1558475400
Provider Name (Legal Business Name): FORT LAUDERDALE EYE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 S PINE ISLAND RD SUITE A100
PLANTATION FL
33324-3118
US

IV. Provider business mailing address

PO BOX 39209
FT LAUDERDALE FL
33339-9209
US

V. Phone/Fax

Practice location:
  • Phone: 954-741-5555
  • Fax: 954-572-9658
Mailing address:
  • Phone: 954-741-5555
  • Fax: 954-572-9658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: KEITH SKOLNICK
Title or Position: OWNER
Credential: M.D.
Phone: 954-741-5555