Provider Demographics
NPI:1568465573
Name:GOROVOY M D EYE SPECIALISTS P A
Entity Type:Organization
Organization Name:GOROVOY M D EYE SPECIALISTS P A
Other - Org Name:MARK S. GOROVOY MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOROVOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-939-1444
Mailing Address - Street 1:12381 S CLEVELAND AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3852
Mailing Address - Country:US
Mailing Address - Phone:239-939-1444
Mailing Address - Fax:239-936-7710
Practice Address - Street 1:12381 S CLEVELAND AVE
Practice Address - Street 2:STE 300
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3852
Practice Address - Country:US
Practice Address - Phone:239-939-1444
Practice Address - Fax:239-936-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL840342207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0328OtherMEDICARE GROUP
FL066657200Medicaid
FL066657200Medicaid