Provider Demographics
NPI:1033269709
Name:EYE SPECIALISTS OF FLORIDA, PA
Entity Type:Organization
Organization Name:EYE SPECIALISTS OF FLORIDA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-242-4556
Mailing Address - Street 1:1715 E HIGHWAY 50
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5187
Mailing Address - Country:US
Mailing Address - Phone:352-243-8704
Mailing Address - Fax:352-243-8705
Practice Address - Street 1:4880 N HIGHWAY 19A
Practice Address - Street 2:SUITE 100
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2018
Practice Address - Country:US
Practice Address - Phone:352-357-8810
Practice Address - Fax:352-357-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1033Medicare ID - Type Unspecified