Provider Demographics
NPI:1598700676
Name:FLORIDA EYE INSTITUTE SURGICENTER LLC
Entity Type:Organization
Organization Name:FLORIDA EYE INSTITUTE SURGICENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-569-9500
Mailing Address - Street 1:2750 INDIAN RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5225
Mailing Address - Country:US
Mailing Address - Phone:772-569-9500
Mailing Address - Fax:772-569-9507
Practice Address - Street 1:2750 INDIAN RIVER BLVD
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5225
Practice Address - Country:US
Practice Address - Phone:772-569-9500
Practice Address - Fax:772-569-9507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL859261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL079122900Medicaid
FL663OtherFL BCBS NO.
FLP00055069OtherRR MEDICARE
FLP00055069OtherRR MEDICARE