Provider Demographics
NPI:1164495198
Name:SARASOTA OPHTHALMOLOGY ASC LLC
Entity Type:Organization
Organization Name:SARASOTA OPHTHALMOLOGY ASC LLC
Other - Org Name:CENTER FOR ADVANCED EYE SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:3920 BEE RIDGE RD
Mailing Address - Street 2:BLDG F, SUITE C
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1207
Mailing Address - Country:US
Mailing Address - Phone:941-925-0000
Mailing Address - Fax:941-927-2726
Practice Address - Street 1:3920 BEE RIDGE RD
Practice Address - Street 2:BLDG F, SUITE C
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1207
Practice Address - Country:US
Practice Address - Phone:941-925-0000
Practice Address - Fax:941-927-2726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL787261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL490005025OtherRAILROAD MEDICARE
FL070947600Medicaid
FL490005025OtherRAILROAD MEDICARE
FLF1215Medicare PIN
FL070947600Medicaid