Provider Demographics
NPI:1023689239
Name:EYE CARE PROFESSIONALS, P.A.
Entity type:Organization
Organization Name:EYE CARE PROFESSIONALS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-301-4637
Mailing Address - Street 1:3674 HAMILTON KY
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-6466
Mailing Address - Country:US
Mailing Address - Phone:561-301-4637
Mailing Address - Fax:561-478-2609
Practice Address - Street 1:2144 W INDIANTOWN RD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5810
Practice Address - Country:US
Practice Address - Phone:561-747-7460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005793702Medicaid