1588656433 NPI number — OCALA EYE PA

Table of content: (NPI 1588656433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588656433 NPI number — OCALA EYE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCALA EYE 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:
OCALA EYE SURGEONS
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:
1588656433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 SE MAGNOLIA EXT STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34471-4452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-622-5183
Provider Business Mailing Address Fax Number:
352-622-1348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4414 SW COLLEGE RD STE 1462
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34474-4790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-622-5183
Provider Business Practice Location Address Fax Number:
352-629-5026
Provider Enumeration Date:
08/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SAMY
Authorized Official First Name:
CHANDER
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
352-622-5183

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)

  • Identifier: 060140300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CF7618 . This is a "RAILROAD GROUP NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 97806 . This is a "BC/BS GROUP NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 060140300 . 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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