1629231394 NPI number — APPLE EYES VISION CENTER

Table of content: (NPI 1629231394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629231394 NPI number — APPLE EYES VISION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPLE EYES VISION CENTER
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:
1629231394
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3101 SW 34TH AVE
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34474-4431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-854-3088
Provider Business Mailing Address Fax Number:
352-854-9501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3101 SW 34TH AVE
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34474-4431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-854-3088
Provider Business Practice Location Address Fax Number:
352-854-9501
Provider Enumeration Date:
07/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
APPELQUIST
Authorized Official First Name:
THEODORE
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER DR
Authorized Official Telephone Number:
352-854-3088

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0919020001 . This is a "PALMETTO GBA-A" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 225225 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 28769 . This is a "SPECTERA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 112668 . This is a "EYEMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 180005596 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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