1750388203 NPI number — EYE ASSOCIATES OF TALLAHASSEE, P.A.

Table of content: (NPI 1750388203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750388203 NPI number — EYE ASSOCIATES OF TALLAHASSEE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE ASSOCIATES OF TALLAHASSEE, P.A.
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:
1750388203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2020 FLEISCHMANN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32308-4599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-878-6161
Provider Business Mailing Address Fax Number:
850-656-0200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 FLEISCHMANN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32308-4599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-878-6161
Provider Business Practice Location Address Fax Number:
850-656-0200
Provider Enumeration Date:
06/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WEAVER
Authorized Official First Name:
TONY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
850-878-6161

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  39777 , 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: 0637408-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180259984 . This is a "TRAVELER'S RAILROAD MED." identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 0539810001 . This is a "PALMETTO GBA MEDICARE P&B" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 063740800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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