Provider Demographics
NPI:1578537270
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:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARM
Authorized Official - Suffix:
Authorized Official - Credentials:
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:407-834-7776
Mailing Address - Fax:407-834-0973
Practice Address - Street 1:407 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3500
Practice Address - Country:US
Practice Address - Phone:321-296-3752
Practice Address - Fax:321-267-9723
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA EYE CLINIC P A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-17
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99259EMedicare PIN
0538340014Medicare NSC