Provider Demographics
NPI:1508301367
Name:ASSOCIATES IN EYECARE OF FLORIDA
Entity Type:Organization
Organization Name:ASSOCIATES IN EYECARE OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:BLISS
Authorized Official - Last Name:DEE-REYES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:239-992-2020
Mailing Address - Street 1:26381 S TAMIAMI TRL STE 112
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7803
Mailing Address - Country:US
Mailing Address - Phone:239-992-2020
Mailing Address - Fax:239-992-2005
Practice Address - Street 1:5995 S POINTE BLVD STE 111
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3273
Practice Address - Country:US
Practice Address - Phone:239-992-2020
Practice Address - Fax:239-992-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP0002994152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU63466Medicare UPIN