1417144668 NPI number — NORTH FLORIDA CATARACT SPECIALISTS AND VISION CARE LLC

Table of content: (NPI 1417144668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417144668 NPI number — NORTH FLORIDA CATARACT SPECIALISTS AND VISION CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH FLORIDA CATARACT SPECIALISTS AND VISION CARE LLC
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:
GAINESVILLE EYE PHYSICIANS
Provider Other Organization Name Type Code:
4
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:
1417144668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
708 E UNIVERSITY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32601-5509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-373-4300
Provider Business Mailing Address Fax Number:
352-372-1641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 STATE ROAD 26
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELROSE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32666-3904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-475-3991
Provider Business Practice Location Address Fax Number:
352-475-3993
Provider Enumeration Date:
10/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SNODGRASS
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
352-373-4300

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  ME50106 , 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)

  • Identifier: 20241 . This is a "BCBS FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 01223 . This is a "BCBS FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 02963 . This is a "BCBS FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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