=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396032645
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATALIYA A. WORSLEY, O.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2011
-----------------------------------------------------
Last Update Date | 11/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2551 E HALLANDALE BEACH BLVD
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-4818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-624-2165
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2551 E HALLANDALE BEACH BLVD
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-4818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-624-2165
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NATALIYA A. WORSLEY, O.D., P.A.
-----------------------------------------------------
Credential | O.D., P.A.
-----------------------------------------------------
Telephone | 954-647-2617
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC 3752
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------