Provider Demographics
NPI:1093309981
Name:GULF BREEZE EYE CARE CORP
Entity Type:Organization
Organization Name:GULF BREEZE EYE CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-542-7555
Mailing Address - Street 1:8550 SCENIC HWY APT F
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7921
Mailing Address - Country:US
Mailing Address - Phone:239-438-8190
Mailing Address - Fax:
Practice Address - Street 1:2650 CREIGHTON RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7382
Practice Address - Country:US
Practice Address - Phone:850-542-7555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service