Provider Demographics
NPI:1114321502
Name:CAPE CORAL EYE CENTER, P.A.
Entity Type:Organization
Organization Name:CAPE CORAL EYE CENTER, P.A.
Other - Org Name:TYSON EYE AT BONITA EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARRELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-542-2020
Mailing Address - Street 1:PO BOX 101427
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33910-1427
Mailing Address - Country:US
Mailing Address - Phone:239-542-2020
Mailing Address - Fax:239-541-1492
Practice Address - Street 1:3925 BONITA BEACH RD
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4112
Practice Address - Country:US
Practice Address - Phone:239-947-6000
Practice Address - Fax:239-947-3914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty