Provider Demographics
NPI:1437269446
Name:WEST COAST EYE INSTITUTE PA
Entity Type:Organization
Organization Name:WEST COAST EYE INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROWDA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-746-2246
Mailing Address - Street 1:240 N LECANTO HWY
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-9191
Mailing Address - Country:US
Mailing Address - Phone:352-746-2246
Mailing Address - Fax:352-746-2807
Practice Address - Street 1:240 N LECANTO HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9191
Practice Address - Country:US
Practice Address - Phone:352-746-2246
Practice Address - Fax:352-746-2807
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST COAST EYE INSTITUTE PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP1974152W00000X
FLOS0004322207W00000X, 332H00000X
FLME0060384207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CN2160OtherRAILROAD MEDICARE
FL378460600Medicaid
FLBCBSOther40218
FL378460601Medicaid
5503208OtherGHI
5503208OtherGHI
FLBCBSOther40218
40218Medicare PIN