MEDICARE: OPHTHALMOLOGY ASSOCIATES OF SOUTH FLORIDA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	OS8684	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7890361	OTHER	FL	AETNA
2	2896366	OTHER	FL	AETNA HMO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215987292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPHTHALMOLOGY ASSOCIATES OF SOUTH FLORIDA PA

Provider Business Mailing Address
First Line	:	3100 CORAL HILLS DR
Second Line	:	206
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4137
Country	:	US
Telephone Number	:	954-575-4711
Fax Number	:	954-575-4722

Provider Business Practice Location Address
First Line	:	3100 CORAL HILLS DR
Second Line	:	206
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4137
Country	:	US
Telephone Number	:	954-575-4711
Fax Number	:	954-575-4722

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HENRY E GLICK
Credential	:	DO
Telephone Number	:	954-575-4711

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	05/05/2008

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