1033269709 NPI number — EYE SPECIALISTS OF FLORIDA, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033269709 NPI number — EYE SPECIALISTS OF FLORIDA, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE SPECIALISTS OF FLORIDA, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033269709
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1715 E HIGHWAY 50
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
CLERMONT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34711-5187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-243-8704
Provider Business Mailing Address Fax Number:
352-243-8705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4880 N HIGHWAY 19A
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MOUNT DORA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32757-2018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-357-8810
Provider Business Practice Location Address Fax Number:
352-357-8811
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
TONYA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
352-242-4556

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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