# PHILIP R SIDRAN, OD, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396042834
- **Authorized official:** DR. PHIIP ROSS SIDRAN O.D. (DOCTOR PRESIDENT)
- **Authorized official phone:** (305) 252-7979

## Contact information

- **Practice address:** 7971 SW 122ND ST, MIAMI, FL 33156-5228
- **Practice address phone:** (305) 252-7979
- **Practice address fax:** (305) 235-0201
- **Mailing address:** 7971 SW 122ND ST, MIAMI, FL 33156-5228
- **Mailing address phone:** (305) 252-7979
- **Mailing address fax:** (305) 235-0201

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OPC804 | FL | Yes |

## Other

- **Enumeration date:** 02/18/2011
- **Last updated:** 02/18/2011