Provider Demographics
NPI:1568556488
Name:SUNCOAST EYE CENTER PA
Entity Type:Organization
Organization Name:SUNCOAST EYE CENTER PA
Other - Org Name:SUNCOAST SURGERY INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-868-9442
Mailing Address - Street 1:14003 LAKESHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7124
Mailing Address - Country:US
Mailing Address - Phone:727-868-9442
Mailing Address - Fax:727-862-6210
Practice Address - Street 1:14003 LAKESHORE BLVD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7124
Practice Address - Country:US
Practice Address - Phone:727-868-9442
Practice Address - Fax:727-862-6210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1026261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL079053200Medicaid
FL687OtherBCBSFL
490001089Medicare PIN
FLF1078Medicare PIN