Provider Demographics
NPI:1245569508
Name:3D VISION EYE SURGERY CENTER PA
Entity Type:Organization
Organization Name:3D VISION EYE SURGERY CENTER PA
Other - Org Name:FERST: FLORIDA EYE RESEARCH AND SURGICAL THERAPY INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-590-3333
Mailing Address - Street 1:1893 N CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5535
Mailing Address - Country:US
Mailing Address - Phone:407-590-3333
Mailing Address - Fax:386-492-7500
Practice Address - Street 1:1893 N CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5535
Practice Address - Country:US
Practice Address - Phone:407-590-3333
Practice Address - Fax:386-492-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80695207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BJ9222376OtherDEA
H29333Medicare UPIN
FLU8288Medicare PIN