Basic Information
| Provider Information | |||||||||
| NPI: | 1760456438 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA EYE CLINIC P A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 BOSTON AVE | ||||||||
| Address2: | |||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327014706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078347776 | ||||||||
| FaxNumber: | 4078340973 | ||||||||
| Practice Location | |||||||||
| Address1: | 229 E RICH AVE | ||||||||
| Address2: | |||||||||
| City: | DELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327244357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867343120 | ||||||||
| FaxNumber: | 3867343125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 11/15/2007 | ||||||||
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| AuthorizedOfficialLastName: | PARM | ||||||||
| AuthorizedOfficialFirstName: | GEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4078347776 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FLORIDA EYE CLINIC PA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 207W00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.