Provider Demographics
NPI:1689996969
Name:SUNCOAST EYEHEALTH P.A.
Entity Type:Organization
Organization Name:SUNCOAST EYEHEALTH P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:941-485-4868
Mailing Address - Street 1:1435 E VENICE AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-3197
Mailing Address - Country:US
Mailing Address - Phone:941-485-4868
Mailing Address - Fax:941-488-7917
Practice Address - Street 1:1435 E VENICE AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3197
Practice Address - Country:US
Practice Address - Phone:941-485-4868
Practice Address - Fax:941-488-7917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-27
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
FL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000P9Other000P9