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General NPI Number Information
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NPI Number | 1144416637
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Entity Type | Organization
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Legal Business Name | AT YOUR HOME EYECARE, PA
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 21214 N SWEETWATER LN
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City | BOCA RATON
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State | FL
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Zip | 33428
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Country | US
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Telephone | 954-536-8905
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Fax | 954-370-4546
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Provider Business Mailing Address
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Address Line | 1856 N NOB HILL RD # 261
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City | PLANTATION
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State | FL
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Zip | 33322-6548
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Country | US
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Telephone | 954-536-8905
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Fax | 954-370-4546
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SETH M BERG
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Credential | OD
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Telephone | 954-536-8905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC3084
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License Number State | FL
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