Provider Demographics
NPI:1649361015
Name:CYRIAC, IGNATIUS C (MD)
Entity type:Individual
Prefix:DR
First Name:IGNATIUS
Middle Name:C
Last Name:CYRIAC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 VONDERBURG DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5982
Mailing Address - Country:US
Mailing Address - Phone:813-681-1122
Mailing Address - Fax:813-684-4924
Practice Address - Street 1:403 VONDERBURG DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5982
Practice Address - Country:US
Practice Address - Phone:813-681-1122
Practice Address - Fax:813-684-4924
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90747207W00000X, 207WX0009X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2699877-00Medicaid
NJ8051003Medicaid
NY0498331OtherGHI
FL47399OtherBCBS FLORIDA
FL5523687OtherAETNA
NJ027433Medicare PIN
FL47399Medicare PIN
GAP00140139Medicare PIN
FL47399YMedicare PIN
FL47399XMedicare PIN
FL47399OtherBCBS FLORIDA
G65696Medicare UPIN
FL47399WMedicare PIN