Provider Demographics
NPI:1144242058
Name:ST LUCIE EYE ASSOCIATES MD PA
Entity Type:Organization
Organization Name:ST LUCIE EYE ASSOCIATES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-461-2020
Mailing Address - Street 1:2201 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-5382
Mailing Address - Country:US
Mailing Address - Phone:772-461-2020
Mailing Address - Fax:772-461-1081
Practice Address - Street 1:2201 S 10TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-5382
Practice Address - Country:US
Practice Address - Phone:772-461-5660
Practice Address - Fax:772-468-2134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063904402Medicaid
FL063904402Medicaid