Provider Demographics
NPI:1821055476
Name:COMMUNITY EYE CENTER
Entity Type:Organization
Organization Name:COMMUNITY EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:E.Q.
Authorized Official - Middle Name:SKIP
Authorized Official - Last Name:FAHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-625-1325
Mailing Address - Street 1:21275 OLEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6704
Mailing Address - Country:US
Mailing Address - Phone:941-625-1325
Mailing Address - Fax:941-625-0131
Practice Address - Street 1:1331 S SUMTER BLVD
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2371
Practice Address - Country:US
Practice Address - Phone:941-423-8137
Practice Address - Fax:941-625-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620805300Medicaid