Provider Demographics
NPI:1437264215
Name:GAINESVILLE EYE PHYSICIANS PA
Entity Type:Organization
Organization Name:GAINESVILLE EYE PHYSICIANS PA
Other - Org Name:GAINESVILLE EYE PHYSICIANS EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:DOY
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 1:708 E UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-5509
Practice Address - Country:US
Practice Address - Phone:352-373-4300
Practice Address - Fax:352-372-1641
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GAINESVILLE EYE PHYSICIANS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-20
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50106207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379409100Medicaid
FL40221Medicare PIN
FL40221BMedicare PIN
FL20828XMedicare PIN
FL1108800003Medicare PIN
FL379409100Medicaid
FL02963Medicare PIN
FL1108800004Medicare NSC
FL1108800002Medicare NSC
FL180025417Medicare PIN
FL01223YMedicare PIN
FL180025416Medicare PIN
FLCC4592Medicare PIN
FL1108800003Medicare NSC
FL180026594Medicare PIN
FL180032446Medicare PIN