Provider Demographics
NPI:1497407480
Name:MINDFUL EYE WELLNESS LLC
Entity Type:Organization
Organization Name:MINDFUL EYE WELLNESS LLC
Other - Org Name:MINDFUL EYE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LYNCH
Authorized Official - Last Name:PHILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:561-313-2807
Mailing Address - Street 1:1080 SW FENWAY RD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2303
Mailing Address - Country:US
Mailing Address - Phone:561-313-2807
Mailing Address - Fax:
Practice Address - Street 1:1645 PALM BEACH LAKES BLVD STE 440
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2217
Practice Address - Country:US
Practice Address - Phone:561-463-4200
Practice Address - Fax:561-469-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty