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General NPI Number Information
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NPI Number | 1215987292
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Entity Type | Organization
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Legal Business Name | OPHTHALMOLOGY ASSOCIATES OF SOUTH FLORIDA PA
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 3100 CORAL HILLS DR 206
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4137
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Country | US
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Telephone | 954-575-4711
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Fax | 954-575-4722
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Provider Business Mailing Address
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Address Line | 3100 CORAL HILLS DR 206
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4137
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Country | US
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Telephone | 954-575-4711
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Fax | 954-575-4722
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HENRY E GLICK
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Credential | DO
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Telephone | 954-575-4711
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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 | OS8684
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License Number State | FL
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