Provider Demographics
NPI:1346993599
Name:PRIMARY EYECARE CENTER, LLC
Entity Type:Organization
Organization Name:PRIMARY EYECARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAZARTE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-243-2020
Mailing Address - Street 1:323 PAGE BACON RD STE 13
Mailing Address - Street 2:
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-1669
Mailing Address - Country:US
Mailing Address - Phone:850-243-2020
Mailing Address - Fax:850-243-6555
Practice Address - Street 1:323 PAGE BACON RD STE 13
Practice Address - Street 2:
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1669
Practice Address - Country:US
Practice Address - Phone:850-243-2020
Practice Address - Fax:850-243-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620189001Medicaid