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General NPI Number Information
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NPI Number | 1306154588
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Entity Type | Organization
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Legal Business Name | FORT LAUDERDALE EYE CARE AND EYEWEAR, LLC
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Dates
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Enumeration Date | 09/21/2010
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 1489 SE 17TH ST SUITE 2J
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City | FT LAUDERDALE
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State | FL
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Zip | 33316-1734
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Country | US
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Telephone | 954-763-2842
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Fax |
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Provider Business Mailing Address
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Address Line | 209 N FORT LAUDERDALE BEACH BLVD UNIT 11G
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City | FT LAUDERDALE
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State | FL
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Zip | 33304-4365
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Country | US
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Telephone | 954-303-6600
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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. DAWN BEARDEN
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Credential | O.D.
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Telephone | 954-303-6600
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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 | OPC2885
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License Number State | FL
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