Provider Demographics
NPI:1093004285
Name:EYE HEALTH OF FT MYERS INC
Entity Type:Organization
Organization Name:EYE HEALTH OF FT MYERS INC
Other - Org Name:EYE HEALTH OF PUNTA GORDA OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:QUIGLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:239-466-9555
Mailing Address - Street 1:6091 S POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4899
Mailing Address - Country:US
Mailing Address - Phone:239-466-9555
Mailing Address - Fax:239-985-7118
Practice Address - Street 1:150 W MCKENZIE ST STE 117
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-5500
Practice Address - Country:US
Practice Address - Phone:941-639-2020
Practice Address - Fax:941-639-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2110332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier