Basic Information
| Provider Information | |||||||||
| NPI: | 1982861175 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EYE PHYSICIANS AND SURGEONS OF FLORIDA PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4790 BARKLEY CIR BLDG C-103 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339077543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399368686 | ||||||||
| FaxNumber: | 2399362532 | ||||||||
| Practice Location | |||||||||
| Address1: | 4790 BARKLEY CIR BLDG C-103 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339077543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399368686 | ||||||||
| FaxNumber: | 2399362532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2008 | ||||||||
| LastUpdateDate: | 12/09/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SNEAD | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2399368686 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.