Basic Information
| Provider Information | |||||||||
| NPI: | 1326049651 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UPPER CAPE OPHTHAMOLOGY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 BRAMBLEBUSH PARK | ||||||||
| Address2: | |||||||||
| City: | FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025402325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085400511 | ||||||||
| FaxNumber: | 5085405186 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 BROTHER GEENEN WAY | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342367102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9415563220 | ||||||||
| FaxNumber: | 9419558214 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 08/08/2019 | ||||||||
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| AuthorizedOfficialLastName: | GOSLEE | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5085400511 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 27269 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | CB5951 | 01 | MA | RAILROAD MEDICARE | OTHER | 9746269 | 05 | MA | MEDICAID | 000000013337 | 01 | MA | BMC HEALTHNET | OTHER | M14222 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER | 701408 | 01 | MA | TUFTS | OTHER |