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General NPI Number Information
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NPI Number | 1558802447
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Entity Type | Organization
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Legal Business Name | PINNACLE ADVANCED EYE CARE
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 18131 NW 66TH CT
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City | HIALEAH
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State | FL
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Zip | 33015-4408
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Country | US
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Telephone | 305-962-1735
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Fax | 954-507-9561
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Provider Business Mailing Address
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Address Line | 18131 NW 66TH CT
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City | HIALEAH
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State | FL
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Zip | 33015-4408
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Country | US
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Telephone | 305-962-1735
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Fax | 954-507-9561
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRADLEY PELTZER
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Credential | O.D.
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Telephone | 305-962-1735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | OPC2646
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License Number State | FL
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