Provider Demographics
NPI:1629161633
Name:PLASTIC EYE SURGERY ASSOCIATES P A
Entity Type:Organization
Organization Name:PLASTIC EYE SURGERY ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:PATRINELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-473-0990
Mailing Address - Street 1:17 E MAIN ST
Mailing Address - Street 2:STE 100
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-5998
Mailing Address - Country:US
Mailing Address - Phone:850-473-0990
Mailing Address - Fax:850-473-0790
Practice Address - Street 1:17 E MAIN ST
Practice Address - Street 2:STE 100
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-5998
Practice Address - Country:US
Practice Address - Phone:850-473-0990
Practice Address - Fax:850-473-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49837173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0481Medicare PIN
B25394Medicare UPIN