Healthcare Provider Details

I. General information

NPI: 1538366901
Provider Name (Legal Business Name): EYE SURGERY ASSOCITES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N COMMERCE PKWY SUITE 307
WESTON FL
33326-3254
US

IV. Provider business mailing address

300 S PARK RD STE 300
HOLLYWOOD FL
33021-8353
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-2740
  • Fax: 954-927-1941
Mailing address:
  • Phone: 954-925-2740
  • Fax: 954-927-1941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: GEORGE L NEAL
Title or Position: PRESIDENT
Credential:
Phone: 469-214-0144