Provider Demographics
NPI:1609086420
Name:PRIMARY EYE CARE GROUP OD PA
Entity Type:Organization
Organization Name:PRIMARY EYE CARE GROUP OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SARNO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-641-6602
Mailing Address - Street 1:8695 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-3103
Mailing Address - Country:US
Mailing Address - Phone:727-641-6602
Mailing Address - Fax:727-578-1510
Practice Address - Street 1:8695 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-3103
Practice Address - Country:US
Practice Address - Phone:727-641-6602
Practice Address - Fax:727-578-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620622100Medicaid
FL0901870001OtherDMEPOS-PALMETTOGBA
FL72798Medicare ID - Type UnspecifiedMEDICARE GROUP #