Provider Demographics
NPI:1447420773
Name:EYE CONSULTANTS OF BONITA SPRINGS PLLC
Entity Type:Organization
Organization Name:EYE CONSULTANTS OF BONITA SPRINGS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PASCUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-949-2021
Mailing Address - Street 1:23451 WALDEN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4919
Mailing Address - Country:US
Mailing Address - Phone:239-949-2021
Mailing Address - Fax:
Practice Address - Street 1:23451 WALDEN CENTER DR
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4919
Practice Address - Country:US
Practice Address - Phone:239-949-2021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88450207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty