Provider Demographics
NPI:1710381405
Name:VOLUSIA EYE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:VOLUSIA EYE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-427-4143
Mailing Address - Street 1:415 N CAUSEWAY
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-5235
Mailing Address - Country:US
Mailing Address - Phone:386-427-4143
Mailing Address - Fax:386-427-0711
Practice Address - Street 1:415 N CAUSEWAY
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-5235
Practice Address - Country:US
Practice Address - Phone:386-427-4143
Practice Address - Fax:386-427-0711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115506174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID