Provider Demographics
NPI:1114113685
Name:CENTRAL FLORIDA EYE CLINIC P.A.
Entity Type:Organization
Organization Name:CENTRAL FLORIDA EYE CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAVITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MULANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-686-1010
Mailing Address - Street 1:814 GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2440
Mailing Address - Country:US
Mailing Address - Phone:863-686-1010
Mailing Address - Fax:863-688-0096
Practice Address - Street 1:814 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2440
Practice Address - Country:US
Practice Address - Phone:863-686-1010
Practice Address - Fax:863-688-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055340156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063671100Medicaid
FL1274490001Medicare NSC
B41012Medicare UPIN
FL063671100Medicaid