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General NPI Number Information
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NPI Number | 1114110426
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Entity Type | Organization
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Legal Business Name | TOWNSHIP EYE ASSOCIATES OF COCONUT CREEK., P.A.
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 08/22/2007
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Provider Practice Location Address
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Address Line | 4400 W SAMPLE RD SUITE 154
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City | COCONUT CREEK
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State | FL
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Zip | 33073-3470
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Country | US
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Telephone | 954-782-9330
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Fax | 954-977-7401
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Provider Business Mailing Address
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Address Line | 4400 W SAMPLE RD SUITE 154
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City | COCONUT CREEK
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State | FL
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Zip | 33073-3470
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Country | US
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Telephone | 954-782-9330
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Fax | 954-977-7401
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOEL NATHAN
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Credential | M.D.
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Telephone | 954-782-9330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME62339
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License Number State | FL
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