Provider Demographics
NPI:1417144668
Name:NORTH FLORIDA CATARACT SPECIALISTS AND VISION CARE LLC
Entity Type:Organization
Organization Name:NORTH FLORIDA CATARACT SPECIALISTS AND VISION CARE LLC
Other - Org Name:GAINESVILLE EYE PHYSICIANS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-373-4300
Mailing Address - Street 1:708 E UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-5509
Mailing Address - Country:US
Mailing Address - Phone:352-373-4300
Mailing Address - Fax:352-372-1641
Practice Address - Street 1:105 STATE ROAD 26
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:FL
Practice Address - Zip Code:32666-3904
Practice Address - Country:US
Practice Address - Phone:352-475-3991
Practice Address - Fax:352-475-3993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2016-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50106207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20241OtherBCBS FLORIDA
FL01223OtherBCBS FLORIDA
FL02963OtherBCBS FLORIDA
FLCC4592Medicare PIN
FL20241OtherBCBS FLORIDA
FL01223OtherBCBS FLORIDA
FL180025416Medicare PIN
FL1108800002Medicare NSC
FL180032446Medicare PIN
FL20241YMedicare PIN
FL410049636Medicare PIN
FL02963XMedicare PIN
FL01223YMedicare PIN
FL20241ZMedicare PIN
FL40221BMedicare PIN
FL02963ZMedicare PIN
FL01223ZMedicare PIN