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General NPI Number Information
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NPI Number | 1154625168
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Entity Type | Organization
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Legal Business Name | BRADENTON EYE CLINIC INC
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Dates
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Enumeration Date | 01/05/2011
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 4812 26TH ST W
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City | BRADENTON
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State | FL
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Zip | 34207-1705
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Country | US
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Telephone | 941-727-3937
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Fax | 941-727-7001
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Provider Business Mailing Address
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Address Line | 4812 26TH ST W
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City | BRADENTON
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State | FL
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Zip | 34207-1705
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Country | US
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Telephone | 941-727-3937
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Fax | 941-727-7001
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LIAQUAT ALLARAKHIA
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Credential | M.D.,
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Telephone | 941-727-3937
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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 | ME0066629
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License Number State | FL
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