Provider Demographics
NPI:1679732978
Name:EYE SOCIETY INC
Entity type:Organization
Organization Name:EYE SOCIETY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD, FAAO, ACOVD
Authorized Official - Phone:305-576-5338
Mailing Address - Street 1:4770 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 550
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3202
Mailing Address - Country:US
Mailing Address - Phone:305-576-5338
Mailing Address - Fax:305-576-5366
Practice Address - Street 1:4770 BISCAYNE BLVD
Practice Address - Street 2:SUITE 550
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3202
Practice Address - Country:US
Practice Address - Phone:305-576-5338
Practice Address - Fax:305-576-5366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620110500Medicaid
FLDD452AMedicare PIN
FL20576Medicare PIN
FL620110500Medicaid