Provider Demographics
NPI:1568136349
Name:NEURO-OPHTHALMOLOGY AND STRABISMUS CONSULTANTS OF SOUTHWEST FLORIDA P
Entity Type:Organization
Organization Name:NEURO-OPHTHALMOLOGY AND STRABISMUS CONSULTANTS OF SOUTHWEST FLORIDA P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCI
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-638-1853
Mailing Address - Street 1:2338 IMMOKALEE RD # 203
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1445
Mailing Address - Country:US
Mailing Address - Phone:239-919-4342
Mailing Address - Fax:
Practice Address - Street 1:9776 BONITA BEACH RD SE STE 202B
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4775
Practice Address - Country:US
Practice Address - Phone:239-308-0063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmologyGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus SpecialistGroup - Multi-Specialty