Provider Demographics
NPI:1609063478
Name:SUN COAST EYE CARE INC
Entity Type:Organization
Organization Name:SUN COAST EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BS, OD
Authorized Official - Phone:727-216-6214
Mailing Address - Street 1:2451 MCMULLEN BOOTH RD
Mailing Address - Street 2:SUITE 221
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759
Mailing Address - Country:US
Mailing Address - Phone:727-216-6214
Mailing Address - Fax:727-431-0363
Practice Address - Street 1:2451 MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE 221
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759
Practice Address - Country:US
Practice Address - Phone:727-216-6214
Practice Address - Fax:727-431-0363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2660152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620094000Medicaid
K0046OtherMEDICARE GROUP NUMBER
FL20571Medicare PIN
FL620094000Medicaid
K0046OtherMEDICARE GROUP NUMBER