Provider Demographics
NPI:1891735411
Name:EYE PHYSICIANS OF CENTRAL FLORIDA
Entity Type:Organization
Organization Name:EYE PHYSICIANS OF CENTRAL FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERCHOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-767-6411
Mailing Address - Street 1:249 MORAY LN
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4122
Mailing Address - Country:US
Mailing Address - Phone:407-645-4350
Mailing Address - Fax:407-645-0337
Practice Address - Street 1:249 MORAY LANE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792
Practice Address - Country:US
Practice Address - Phone:407-645-4350
Practice Address - Fax:407-767-8160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97664OtherBLUE CROSS
FL4038523OtherAETNA
FL057983100Medicaid
FLCB8207Medicare PIN
FL97664Medicare PIN
FL0973100002Medicare NSC