1184788283 NPI number — EAST FLORIDA EYE INSTITUTE 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 1184788283 NPI number — EAST FLORIDA EYE INSTITUTE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST FLORIDA EYE INSTITUTE 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:
1184788283
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 896
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STUART
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34995-0896
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-287-9000
Provider Business Mailing Address Fax Number:
772-287-0507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 SE RIVERSIDE DR
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34994-2579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-287-9000
Provider Business Practice Location Address Fax Number:
772-287-0507
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRENKEL
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
ERIC PRENTIS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
772-287-9000

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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