Provider Demographics
NPI:1376581959
Name:CALOOSA EYE CENTER PA
Entity Type:Organization
Organization Name:CALOOSA EYE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-278-4733
Mailing Address - Street 1:1560 MATTHEW DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1702
Mailing Address - Country:US
Mailing Address - Phone:239-278-4733
Mailing Address - Fax:239-278-4730
Practice Address - Street 1:1560 MATTHEW DR
Practice Address - Street 2:SUITE G
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1702
Practice Address - Country:US
Practice Address - Phone:239-278-4733
Practice Address - Fax:239-278-4730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ240Medicare PIN