Provider Demographics
NPI:1164638680
Name:EMERALD COAST EYE INSTITUTE, LLC
Entity Type:Organization
Organization Name:EMERALD COAST EYE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:POPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-862-4001
Mailing Address - Street 1:911 MAR WALT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6705
Mailing Address - Country:US
Mailing Address - Phone:850-862-4001
Mailing Address - Fax:850-862-1612
Practice Address - Street 1:911 MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6705
Practice Address - Country:US
Practice Address - Phone:850-862-4001
Practice Address - Fax:850-862-1612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4889100001Medicare ID - Type UnspecifiedDMR NUMBER