Provider Demographics
NPI:1740600790
Name:WEST COAST EYE INSTITUTE PA
Entity Type:Organization
Organization Name:WEST COAST EYE INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROWDA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-746-2246
Mailing Address - Street 1:240 N LECANTO HWY
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-9191
Mailing Address - Country:US
Mailing Address - Phone:352-746-2246
Mailing Address - Fax:352-746-2807
Practice Address - Street 1:212 S APOPKA AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4803
Practice Address - Country:US
Practice Address - Phone:352-419-8928
Practice Address - Fax:352-746-2807
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST COAST EYE INSTITUTE PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4215152W00000X, 152WL0500X
FLOS4322207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40218Medicare PIN