Provider Demographics
NPI:1164421418
Name:EYE OF HORUS PA
Entity Type:Organization
Organization Name:EYE OF HORUS PA
Other - Org Name:WEST BOCA EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, WEST BOCA EYE CENTER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-488-1001
Mailing Address - Street 1:9325 GLADES ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3405
Mailing Address - Country:US
Mailing Address - Phone:561-488-1001
Mailing Address - Fax:
Practice Address - Street 1:9325 GLADES RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3907
Practice Address - Country:US
Practice Address - Phone:561-488-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 93252207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7456729OtherAETNA
FLDE5206OtherRAIL ROAD MEDICARE
FL08-00553OtherUNITED HEALTH CARE
FL63665OtherGREAT WEST HEALTH CARE
FLPCS1492OtherPARTNER CARE