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General NPI Number Information
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NPI Number | 1053720219
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Entity Type | Organization
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Legal Business Name | EYE MANAGEMENT OF PUERTO RICO, LLC
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Dates
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Enumeration Date | 08/12/2014
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 2001 S ANDREWS AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-3429
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Country | US
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Telephone | 855-549-5480
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Fax | 855-549-5481
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Provider Business Mailing Address
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Address Line | 2001 S ANDREWS AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-3429
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Country | US
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Telephone | 855-549-5480
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Fax | 855-549-5481
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARTIN E BILOWICH
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Credential |
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Telephone | 305-614-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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