Provider Demographics
NPI:1245611268
Name:PANHANDLE CATARACT AND LASER INSTITUTE LLC
Entity Type:Organization
Organization Name:PANHANDLE CATARACT AND LASER INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:H
Authorized Official - Last Name:SPEAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-438-1277
Mailing Address - Street 1:5101 N. DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2040
Mailing Address - Country:US
Mailing Address - Phone:850-438-1277
Mailing Address - Fax:850-438-1278
Practice Address - Street 1:5101 N. DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2040
Practice Address - Country:US
Practice Address - Phone:850-438-1277
Practice Address - Fax:850-438-1278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620994700Medicaid
FLK6972Medicare PIN