Provider Demographics
NPI:1407995962
Name:EYE ASSOCIATES OF WINTER PARK
Entity Type:Organization
Organization Name:EYE ASSOCIATES OF WINTER PARK
Other - Org Name:EYE ASSOCIATES OF WINTER PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-671-5445
Mailing Address - Street 1:1928 HOWELL BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1013
Mailing Address - Country:US
Mailing Address - Phone:407-671-5445
Mailing Address - Fax:407-671-2899
Practice Address - Street 1:1928 HOWELL BRANCH RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1013
Practice Address - Country:US
Practice Address - Phone:407-671-5445
Practice Address - Fax:407-671-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084757700Medicaid
0912730001Medicare NSC
FL72804Medicare PIN