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General NPI Number Information
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NPI Number | 1467788430
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Entity Type | Organization
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Legal Business Name | FLORIDA EYECARE CONSULTANTS P.A.
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Dates
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Enumeration Date | 10/27/2009
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Last Update Date | 09/17/2020
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Provider Practice Location Address
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Address Line | 7480 NW 10TH PL
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City | PLANTATION
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State | FL
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Zip | 33313-5911
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Country | US
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Telephone | 954-667-9316
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Fax |
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Provider Business Mailing Address
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Address Line | 7480 NW 10TH PL
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City | PLANTATION
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State | FL
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Zip | 33313-5911
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Country | US
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Telephone | 954-667-9316
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | GRAHAM RASANEN
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Credential | OD
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Telephone | 954-667-9316
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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 | OPC 4449
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License Number State | FL
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