Provider Demographics
NPI:1477692135
Name:PRIMARY EYE CARE CENTER
Entity Type:Organization
Organization Name:PRIMARY EYE CARE CENTER
Other - Org Name:JOSEPH M. BAZARTE OD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAZARTE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-243-2020
Mailing Address - Street 1:323 PAGE BACON RD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-1610
Mailing Address - Country:US
Mailing Address - Phone:850-243-7100
Mailing Address - Fax:850-243-6555
Practice Address - Street 1:323 PAGE BACON RD
Practice Address - Street 2:SUITE 13
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1610
Practice Address - Country:US
Practice Address - Phone:850-243-7100
Practice Address - Fax:850-243-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001596152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620189001Medicaid
FL620189001Medicaid
FL620189001Medicaid
FL0865500001Medicare NSC