Provider Demographics
NPI:1619119948
Name:CRYSTAL RIVER EYE CENTER,LLC
Entity Type:Organization
Organization Name:CRYSTAL RIVER EYE CENTER,LLC
Other - Org Name:ENVISION EYE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:I
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-795-6622
Mailing Address - Street 1:PO BOX 3979
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34230-3979
Mailing Address - Country:US
Mailing Address - Phone:523-795-6622
Mailing Address - Fax:352-563-2598
Practice Address - Street 1:295 SE US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4880
Practice Address - Country:US
Practice Address - Phone:216-338-7773
Practice Address - Fax:352-563-2598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME061395207W00000X
FLME61395207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Multi-Specialty