Provider Demographics
NPI:1235107103
Name:EBMEIER, PAMELA LEIGH (OD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:LEIGH
Last Name:EBMEIER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:EBMEIER
Other - Last Name:MONTMENY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2641 E OAKLAND PARK BLVD
Mailing Address - Street 2:#3
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1665
Mailing Address - Country:US
Mailing Address - Phone:954-563-2211
Mailing Address - Fax:954-563-3919
Practice Address - Street 1:2641 E OAKLAND PARK BLVD
Practice Address - Street 2:#3
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1665
Practice Address - Country:US
Practice Address - Phone:954-563-2211
Practice Address - Fax:954-563-3919
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2585152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620082600Medicaid
FL20419Medicare ID - Type Unspecified
FL620082600Medicaid
FL3920370001Medicare NSC
FL20419Medicare PIN