Provider Demographics
NPI:1689904666
Name:EYECARE PARTNERS OF SOUTHWEST FLORIDA LLC
Entity Type:Organization
Organization Name:EYECARE PARTNERS OF SOUTHWEST FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:PUTRINO
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:941-441-7581
Mailing Address - Street 1:5265 UNIVERSITY PKWY
Mailing Address - Street 2:UNIT 101
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34201-3000
Mailing Address - Country:US
Mailing Address - Phone:941-441-7581
Mailing Address - Fax:
Practice Address - Street 1:5265 UNIVERSITY PKWY
Practice Address - Street 2:UNIT 101
Practice Address - City:UNIVERSITY PARK
Practice Address - State:FL
Practice Address - Zip Code:34201-3000
Practice Address - Country:US
Practice Address - Phone:941-441-7581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1957152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT54799Medicare UPIN
FL19252Medicare PIN