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General NPI Number Information
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NPI Number | 1255352258
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Entity Type | Organization
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Legal Business Name | STEVEN WIGDOR O.D. P.A.
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 17941 BISCAYNE BLVD
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City | AVENTURA
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State | FL
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Zip | 33160-2502
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Country | US
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Telephone | 305-931-0225
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Fax | 305-931-0238
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Provider Business Mailing Address
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Address Line | 17941 BISCAYNE BLVD
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City | AVENTURA
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State | FL
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Zip | 33160-2502
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Country | US
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Telephone | 305-931-0225
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Fax | 305-931-0238
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN WIGDOR
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Credential | O.D.
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Telephone | 305-931-0225
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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 | OPC1791
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License Number State | FL
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