Provider Demographics
NPI:1487853321
Name:GROOM EYE CENTER PLC
Entity Type:Organization
Organization Name:GROOM EYE CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:GROOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-597-5700
Mailing Address - Street 1:3455 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3824
Mailing Address - Country:US
Mailing Address - Phone:239-597-5700
Mailing Address - Fax:239-597-3500
Practice Address - Street 1:3455 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-3824
Practice Address - Country:US
Practice Address - Phone:239-597-5700
Practice Address - Fax:239-597-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65790207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty