Provider Demographics
NPI:1760718936
Name:EYE SPECIALISTS OF MID FLORIDA, PA
Entity Type:Organization
Organization Name:EYE SPECIALISTS OF MID FLORIDA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-294-3504
Mailing Address - Street 1:407 AVENUE K SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4126
Mailing Address - Country:US
Mailing Address - Phone:863-294-3504
Mailing Address - Fax:863-294-8305
Practice Address - Street 1:1050 US HIGHWAY 27
Practice Address - Street 2:SUITE 1
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-7508
Practice Address - Country:US
Practice Address - Phone:352-394-8705
Practice Address - Fax:352-394-2074
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE SPECIALISTS OF MID FLORIDA, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-23
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32357207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0585110003OtherDMERC
0585110003OtherDMERC