Provider Demographics
NPI:1609026533
Name:EYE SURGICENTER LLC
Entity Type:Organization
Organization Name:EYE SURGICENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:FELIX
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-244-0671
Mailing Address - Street 1:2521 NW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6630
Mailing Address - Country:US
Mailing Address - Phone:352-244-0671
Mailing Address - Fax:352-244-0681
Practice Address - Street 1:2521 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6630
Practice Address - Country:US
Practice Address - Phone:352-244-0671
Practice Address - Fax:352-244-0681
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE SURGICENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-29
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL982261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
F1053Medicare PIN