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General NPI Number Information
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NPI Number | 1235491820
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Entity Type | Organization
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Legal Business Name | MITCHELL J MARDER P.A.
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Dates
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Enumeration Date | 06/11/2012
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 4923 COCONUT CREEK PKWY
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City | COCONUT CREEK
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State | FL
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Zip | 33063-3909
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Country | US
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Telephone | 954-970-4266
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Fax |
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Provider Business Mailing Address
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Address Line | 11368 ISLAND LAKES LN
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City | BOCA RATON
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State | FL
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Zip | 33498-6805
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Country | US
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Telephone | 561-445-3086
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MITCHELL J MARDER
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Credential | O.D.
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Telephone | 561-445-3086
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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 | OPC001674
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License Number State | FL
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