Provider Demographics
NPI:1891736526
Name:ROBERT W DOUVILLE MD PA
Entity Type:Organization
Organization Name:ROBERT W DOUVILLE MD PA
Other - Org Name:KEY WEST EYE CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-294-8494
Mailing Address - Street 1:1111 12TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4088
Mailing Address - Country:US
Mailing Address - Phone:305-294-8494
Mailing Address - Fax:
Practice Address - Street 1:1111 12TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4088
Practice Address - Country:US
Practice Address - Phone:305-294-8494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEP282AMedicare PIN