Provider Demographics
NPI:1659641371
Name:ST. CLOUD EYE CENTER INC
Entity Type:Organization
Organization Name:ST. CLOUD EYE CENTER INC
Other - Org Name:EYE FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAIN
Authorized Official - Prefix:DR
Authorized Official - First Name:LY
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-891-2010
Mailing Address - Street 1:1141 MIRANDA LANE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-1604
Mailing Address - Country:US
Mailing Address - Phone:407-891-2010
Mailing Address - Fax:407-891-8211
Practice Address - Street 1:1523 E OSCEOLA PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1604
Practice Address - Country:US
Practice Address - Phone:407-891-2010
Practice Address - Fax:407-891-8211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94908332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCB2289Medicare UPIN