Provider Demographics
NPI:1184190720
Name:PALM VALLEY EYE CARE AND SURGEONS, LLC
Entity Type:Organization
Organization Name:PALM VALLEY EYE CARE AND SURGEONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:SCOTT CARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-712-3315
Mailing Address - Street 1:151 SAWGRASS CORNERS DR STE 208
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3553
Mailing Address - Country:US
Mailing Address - Phone:904-712-3315
Mailing Address - Fax:904-712-3316
Practice Address - Street 1:151 SAWGRASS CORNERS DR STE 208
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3553
Practice Address - Country:US
Practice Address - Phone:904-712-3315
Practice Address - Fax:904-712-3316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL722671Medicaid