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General NPI Number Information
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NPI Number | 1295164648
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Entity Type | Organization
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Legal Business Name | IVANA V OBRADOVIC OD PA
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Dates
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Enumeration Date | 11/06/2013
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 1900 S UNIVERSITY DR
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City | MIRAMAR
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State | FL
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Zip | 33025-2230
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Country | US
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Telephone | 954-431-3060
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Fax | 954-431-4002
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Provider Business Mailing Address
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Address Line | 1900 S UNIVERSITY DR
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City | MIRAMAR
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State | FL
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Zip | 33025-2230
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Country | US
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Telephone | 954-431-3060
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Fax | 954-431-4002
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. IVANA OBRADOVIC
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Credential | OD
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Telephone | 954-431-3060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | OPC4521
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License Number State | FL
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