Provider Demographics
NPI:1437482924
Name:FORT MYERS EYE SURGERY CENTER LLC
Entity Type:Organization
Organization Name:FORT MYERS EYE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TYNDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-791-0013
Mailing Address - Street 1:4790 BARKLEY CIR
Mailing Address - Street 2:BUILDING C, UNIT 101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7543
Mailing Address - Country:US
Mailing Address - Phone:239-277-1778
Mailing Address - Fax:239-277-1779
Practice Address - Street 1:4790 BARKLEY CIR
Practice Address - Street 2:BUILDING C UNIT 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7543
Practice Address - Country:US
Practice Address - Phone:239-277-1778
Practice Address - Fax:239-277-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical