Provider Demographics
NPI:1891024428
Name:PASADENA EYE CENTER, LLC
Entity Type:Organization
Organization Name:PASADENA EYE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-343-3004
Mailing Address - Street 1:6950 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1210
Mailing Address - Country:US
Mailing Address - Phone:727-343-3004
Mailing Address - Fax:727-343-9521
Practice Address - Street 1:6950 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1210
Practice Address - Country:US
Practice Address - Phone:727-343-3004
Practice Address - Fax:727-343-9521
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PASADENA EYE CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5451200001OtherMEDICARE DME