Provider Demographics
NPI:1669650305
Name:ADVANCED SURGICAL AND MEDICAL EYE CARE
Entity Type:Organization
Organization Name:ADVANCED SURGICAL AND MEDICAL EYE CARE
Other - Org Name:EYES AT THE VILLAGES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-753-9888
Mailing Address - Street 1:936 BICHARA BLVD
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-7714
Mailing Address - Country:US
Mailing Address - Phone:352-753-9888
Mailing Address - Fax:352-753-0947
Practice Address - Street 1:8784 SE 165TH MULBERRY LN
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5861
Practice Address - Country:US
Practice Address - Phone:352-753-4530
Practice Address - Fax:352-259-5862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2612152W00000X
FLME0071525207W00000X
FLME89546207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1219930002OtherDME
FLK1349OtherMEDICARE ID
FL1219930002Medicare NSC