=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972707859
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIDTOWN EYE CARE, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2007
-----------------------------------------------------
Last Update Date | 04/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 599 S FEDERAL HWY SUITE 102
-----------------------------------------------------
City | DANIA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33004-4174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-927-2020
-----------------------------------------------------
Fax | 954-927-3418
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 599 S FEDERAL HWY SUITE 102
-----------------------------------------------------
City | DANIA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33004-4174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-927-2020
-----------------------------------------------------
Fax | 954-927-3418
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BRADLEY A PELTZER
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 305-573-2090
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC0002646
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------