Island City Eyecare LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC001072 Issued in FL

Legal business name

ISLAND CITY EYECARE LLC

Practice address

2301 Wilton Dr
Unit C1
Wilton Manors, FL 33305-1202

Phone

(954) 764-6906

Fax

(954) 463-7933

NPI assigned

May 6, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sandra Brauss

Title

Secretary

Phone

(954) 764-6906

Specialties & licenses 1

Addresses

Other identifiers 10

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399420800000",
    "number": "1649446097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 WILTON DR",
            "address_2": "UNIT C1",
            "city": "WILTON MANORS",
            "state": "FL",
            "postal_code": "333051202",
            "telephone_number": "954-764-6906",
            "fax_number": "954-463-7933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 WILTON DR",
            "address_2": "UNIT C1",
            "city": "WILTON MANORS",
            "state": "FL",
            "postal_code": "333051202",
            "telephone_number": "954-764-6906",
            "fax_number": "954-463-7933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND CITY EYECARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-06",
        "last_updated": "2014-05-07",
        "status": "A",
        "authorized_official_last_name": "BRAUSS",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "954-764-6906"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC001072",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "078966600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000J1",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084758500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "20512",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "321773",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "19523",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "3446264",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC CIGNA",
            "identifier": "6374970001",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "220833",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "621354500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Wilton Manors, FL
• Providers in Wilton Manors, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.