1912310780 NPI number — CAPE CORAL EYE CENTER, P.A.

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 1912310780 NPI number — CAPE CORAL EYE CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPE CORAL EYE CENTER, 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:
6
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:
1912310780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 101427
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPE CORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33910-1427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-542-2020
Provider Business Mailing Address Fax Number:
239-541-1492

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2335 TAMIAMI TRL N STE 304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34103-4457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-542-2020
Provider Business Practice Location Address Fax Number:
239-542-0704
Provider Enumeration Date:
06/09/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TYSON
Authorized Official First Name:
FARRELL
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR/ OWNER
Authorized Official Telephone Number:
239-542-2020

Provider Taxonomy Codes

  • Taxonomy code: 261QS0132X , with the licence number:  ME81910 , 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)