Provider Demographics
NPI:1740397157
Name:THE EYE ASSOCIATES OF MANATEE, LLP
Entity Type:Organization
Organization Name:THE EYE ASSOCIATES OF MANATEE, LLP
Other - Org Name:THE OPTICAL GALLERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER/MANAGING EM
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-792-2020
Mailing Address - Street 1:2203 61ST ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5528
Mailing Address - Country:US
Mailing Address - Phone:941-792-2020
Mailing Address - Fax:941-798-3995
Practice Address - Street 1:2203 61ST ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5528
Practice Address - Country:US
Practice Address - Phone:941-792-2020
Practice Address - Fax:941-798-3995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
FL332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0544050001Medicare NSC