Provider Demographics
NPI:1396858098
Name:GOROVOY MD EYE SPECIALISTS
Entity Type:Organization
Organization Name:GOROVOY MD EYE SPECIALISTS
Other - Org Name:OPTICAL SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOROVOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-939-1444
Mailing Address - Street 1:12381 S CLEVELAND AVE
Mailing Address - Street 2:SUITE #300
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3893
Mailing Address - Country:US
Mailing Address - Phone:239-939-1444
Mailing Address - Fax:239-936-7710
Practice Address - Street 1:12381 S CLEVELAND AVE
Practice Address - Street 2:SUITE #300
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3893
Practice Address - Country:US
Practice Address - Phone:239-939-1444
Practice Address - Fax:239-936-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL840342332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier