Provider Demographics
NPI:1487831830
Name:DE ZAYAS EYE ASSOCIATES, PA
Entity Type:Organization
Organization Name:DE ZAYAS EYE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:DE ZAYAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-632-0012
Mailing Address - Street 1:1282 S US HIGHWAY 1
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2747
Mailing Address - Country:US
Mailing Address - Phone:321-632-0012
Mailing Address - Fax:321-632-8532
Practice Address - Street 1:1282 S US HIGHWAY 1
Practice Address - Street 2:SUITE 2
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2747
Practice Address - Country:US
Practice Address - Phone:321-632-0012
Practice Address - Fax:321-632-8532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51039207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062269901Medicaid
FL062269901Medicaid
FLB14925Medicare UPIN