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General NPI Number Information
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NPI Number | 1447427141
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Entity Type | Organization
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Legal Business Name | PEARTREE EYECARE PA
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 11300 LEGACY AVE UNIT 110
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-3656
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Country | US
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Telephone | 561-493-8915
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Fax |
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Provider Business Mailing Address
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Address Line | 6531 MAGGIORE DR
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City | BOYNTON BEACH
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State | FL
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Zip | 33472-2555
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. SUZANNE J. BIRNBAUM
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Credential | O.D.
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Telephone | 954-655-6645
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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 | OPC4207
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License Number State | FL
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