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General NPI Number Information
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NPI Number | 1306590443
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Entity Type | Organization
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Legal Business Name | SSK OPHTHALMOLOGY LLC
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Dates
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Enumeration Date | 02/08/2022
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Last Update Date | 12/31/2023
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Provider Practice Location Address
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Address Line | 1000 37TH PL STE 101
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City | VERO BEACH
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State | FL
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Zip | 32960-6579
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Country | US
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Telephone | 772-758-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 37TH PL STE 101
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City | VERO BEACH
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State | FL
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Zip | 32960-6579
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Country | US
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Telephone | 772-758-1000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARAH KHODADADEH
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Credential | MD
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Telephone | 772-758-1000
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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 |
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License Number State |
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