Provider Demographics
NPI:1093776221
Name:C&D EYE CARE PA
Entity Type:Organization
Organization Name:C&D EYE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:MANGATT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-383-6944
Mailing Address - Street 1:4125 CLEVELAND AVE
Mailing Address - Street 2:SEARS OPTICAL STE 88
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9046
Mailing Address - Country:US
Mailing Address - Phone:239-693-3937
Mailing Address - Fax:239-939-3664
Practice Address - Street 1:4125 CLEVELAND AVE
Practice Address - Street 2:SEARS OPTICAL STE 88
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9046
Practice Address - Country:US
Practice Address - Phone:239-693-3937
Practice Address - Fax:239-939-3664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty