Provider Demographics
NPI:1528032299
Name:FLORIDA EYE CLINIC P A
Entity Type:Organization
Organization Name:FLORIDA EYE CLINIC P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-834-7776
Mailing Address - Street 1:160 BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4706
Mailing Address - Country:US
Mailing Address - Phone:407-339-0303
Mailing Address - Fax:407-339-0961
Practice Address - Street 1:345 W. MICHIGAN ST.
Practice Address - Street 2:STE. 118
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4465
Practice Address - Country:US
Practice Address - Phone:407-896-0324
Practice Address - Fax:407-896-2488
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLROIDA EYE CLINIC P A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-17
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL208488103Medicaid
0538340013Medicare NSC
FL208488103Medicaid