Provider Demographics
NPI:1669640751
Name:EYES ON THE BAY PA
Entity Type:Organization
Organization Name:EYES ON THE BAY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:G
Authorized Official - Last Name:ELLIOT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-487-2777
Mailing Address - Street 1:20449 STATE ROAD 7 STE A4
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6776
Mailing Address - Country:US
Mailing Address - Phone:561-487-2777
Mailing Address - Fax:561-482-3247
Practice Address - Street 1:20449 STATE ROAD 7 STE A4
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-6776
Practice Address - Country:US
Practice Address - Phone:561-487-2777
Practice Address - Fax:561-482-3247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2011-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1737152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT85278Medicare UPIN
FL19466Medicare PIN
FL0553330001Medicare NSC