MEDICARE: MIRAMAR EYE CENTER LLC

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

General Provider Information

NPI Number	:	1417416975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRAMAR EYE CENTER LLC

Provider Business Mailing Address
First Line	:	6448 PEMBROKE RD
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-2138
Country	:	US
Telephone Number	:	954-431-2020
Fax Number	:	954-435-7124

Provider Business Practice Location Address
First Line	:	6448 PEMBROKE RD
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-2138
Country	:	US
Telephone Number	:	954-431-2020
Fax Number	:	954-435-7124

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	DR. SALAHUDDIN MASTERS
Credential	:	OD
Telephone Number	:	954-326-0423

Provider Enumeration Date	:	03/14/2019
Last Update Date	:	03/14/2019

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Directions to “MIRAMAR EYE CENTER LLC ” Practice Location

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