Provider Demographics
NPI:1558467167
Name:WOODBINE EYE CARE, PA
Entity Type:Organization
Organization Name:WOODBINE EYE CARE, PA
Other - Org Name:WOODBINE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:MCDOWELL
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-995-3232
Mailing Address - Street 1:5389 WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8765
Mailing Address - Country:US
Mailing Address - Phone:850-995-3232
Mailing Address - Fax:850-995-2606
Practice Address - Street 1:5389 WOODBINE RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8765
Practice Address - Country:US
Practice Address - Phone:850-995-3232
Practice Address - Fax:850-995-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3207152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3910830001Medicare NSC