Provider Demographics
NPI:1063636355
Name:LC EYE CENTER INC
Entity Type:Organization
Organization Name:LC EYE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-650-5075
Mailing Address - Street 1:745 N MAGNOLIA AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3835
Mailing Address - Country:US
Mailing Address - Phone:407-650-5075
Mailing Address - Fax:407-650-5077
Practice Address - Street 1:745 N MAGNOLIA AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3835
Practice Address - Country:US
Practice Address - Phone:407-650-5075
Practice Address - Fax:407-650-5077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59892207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2448Medicare PIN