Provider Demographics
NPI:1043564982
Name:NORTH FLORIDA CATARACT SPECIALISTS AND VISION CARE LLC
Entity Type:Organization
Organization Name:NORTH FLORIDA CATARACT SPECIALISTS AND VISION CARE LLC
Other - Org Name:GAINESVILLE EYE PHYSICIANS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER, MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:DOY
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-333-1186
Mailing Address - Street 1:12921 SW 1ST RD STE 107
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-5709
Mailing Address - Country:US
Mailing Address - Phone:352-333-1186
Mailing Address - Fax:352-333-1188
Practice Address - Street 1:12921 SW 1ST RD STE 107
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-5709
Practice Address - Country:US
Practice Address - Phone:352-333-1186
Practice Address - Fax:352-333-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50106207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1108800004Medicare NSC
FLIN729AMedicare PIN
FL40221Medicare PIN