Provider Demographics
NPI:1679236822
Name:MIAMI GARDENS EYE CARE II
Entity type:Organization
Organization Name:MIAMI GARDENS EYE CARE II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-621-3830
Mailing Address - Street 1:18383 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-3169
Mailing Address - Country:US
Mailing Address - Phone:305-621-3830
Mailing Address - Fax:305-621-3831
Practice Address - Street 1:18383 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-3169
Practice Address - Country:US
Practice Address - Phone:305-621-3830
Practice Address - Fax:305-621-3831
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIAMI GARDENS EYE CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101627800Medicaid