Provider Demographics
NPI:1144466848
Name:DAVIE BLVD. VISION CENTER
Entity type:Organization
Organization Name:DAVIE BLVD. VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:CLIFTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-339-5794
Mailing Address - Street 1:3252 DAVIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-2766
Mailing Address - Country:US
Mailing Address - Phone:954-587-2020
Mailing Address - Fax:954-587-6563
Practice Address - Street 1:3252 DAVIE BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-2766
Practice Address - Country:US
Practice Address - Phone:954-587-2020
Practice Address - Fax:954-587-6563
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHEN ROTHSTEIN, OD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1180152WC0802X, 152WP0200X, 152W00000X
156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621119401Medicaid
FL19375Medicare PIN