Provider Demographics
NPI:1548301757
Name:HANDLEY, DOUGLAS MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:HANDLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 PARKVIEW DR APT 1010
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2934
Mailing Address - Country:US
Mailing Address - Phone:954-593-0574
Mailing Address - Fax:305-932-1948
Practice Address - Street 1:20335 BISCAYNE BLVD STE 25
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1514
Practice Address - Country:US
Practice Address - Phone:305-932-2020
Practice Address - Fax:305-932-1948
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3651152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC 3651Medicare UPIN
FLE7569Medicare ID - Type Unspecified