Provider Demographics
NPI:1508063884
Name:CENTRAL FLORIDA CATARACT AND LASER SURGERY CENTER, INC.
Entity Type:Organization
Organization Name:CENTRAL FLORIDA CATARACT AND LASER SURGERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:386-734-4431
Mailing Address - Street 1:801 N STONE ST
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3255
Mailing Address - Country:US
Mailing Address - Phone:386-734-4431
Mailing Address - Fax:386-738-1045
Practice Address - Street 1:801 N STONE ST
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3255
Practice Address - Country:US
Practice Address - Phone:386-734-4431
Practice Address - Fax:386-738-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH16472261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1005Medicare PIN