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General NPI Number Information
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NPI Number | 1457323107
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Entity Type | Organization
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Legal Business Name | BOCA RATON OPHTHALMOLOGY ASC LLC
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 950 NW 13TH ST
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City | BOCA RATON
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State | FL
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Zip | 33486-2310
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Country | US
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Telephone | 561-391-7642
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Fax | 561-391-2854
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Provider Business Mailing Address
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Address Line | 1A BURTON HILLS BLVD # L&C
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City | NASHVILLE
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State | TN
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Zip | 37215-6187
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Country | US
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Telephone | 615-240-3820
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Fax | 615-234-1720
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JEFFREY SNODGRASS
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Credential |
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Telephone | 615-665-1283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 1073
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License Number State | FL
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