=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912197369
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH MIAMI BEACH EYE CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2007
-----------------------------------------------------
Last Update Date | 02/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 NE 164TH ST
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33162-4121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-940-0037
-----------------------------------------------------
Fax | 305-940-1070
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 NE 164TH ST
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33162-4121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-940-0037
-----------------------------------------------------
Fax | 305-940-1070
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LEON M SHECHTMAN
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 305-940-0037
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC3276
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------