Provider Demographics
NPI:1629274055
Name:EUGENIO F BIRD MD PA
Entity Type:Organization
Organization Name:EUGENIO F BIRD MD PA
Other - Org Name:BIRD EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUGENIO
Authorized Official - Middle Name:F
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-644-4477
Mailing Address - Street 1:895 OUTER ROAD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6652
Mailing Address - Country:US
Mailing Address - Phone:407-644-4477
Mailing Address - Fax:407-644-9549
Practice Address - Street 1:895 OUTER ROAD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6652
Practice Address - Country:US
Practice Address - Phone:407-644-4477
Practice Address - Fax:407-644-9549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4255152W00000X
FLME57203174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063398401Medicaid
FL063398401Medicaid
FLB89822Medicare UPIN
FL1203170001Medicare NSC