Provider Demographics
NPI:1629104674
Name:ADVANCED MEDICAL EYE CONSULTANTS LLC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL EYE CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:L.D. IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-382-7300
Mailing Address - Street 1:PO BOX 1195
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33871-1195
Mailing Address - Country:US
Mailing Address - Phone:863-382-7300
Mailing Address - Fax:786-243-0007
Practice Address - Street 1:6801 US HIGHWAY 27 N
Practice Address - Street 2:SUITE D-3
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-7840
Practice Address - Country:US
Practice Address - Phone:863-382-7300
Practice Address - Fax:486-243-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1790831220OtherINDIVIDUAL NPI