Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC001423 | FL |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPC001423 | FL |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | OPC001423 | FL |
N | 152WP0200X | Pediatric Optomitrist | OPC001423 | FL |
NPI | 1205826138 |
---|---|
Provider Name | Dr. Sheldon H. Kreda |
First Address | Lauderhill, FL 33319-2122 |
Second Address | Lauderhill, FL 33319-2122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2005 |
Last Update Date | 30/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
084938300 | (05) | FL |
T54798 | (02) | FL |