Provider Demographics
NPI:1922030519
Name:SARASOTA OPHTHALMOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:SARASOTA OPHTHALMOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:K
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-556-3762
Mailing Address - Street 1:2121 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3804
Mailing Address - Country:US
Mailing Address - Phone:941-955-6363
Mailing Address - Fax:941-556-3768
Practice Address - Street 1:2121 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3804
Practice Address - Country:US
Practice Address - Phone:941-955-6363
Practice Address - Fax:941-556-3768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5683Medicare ID - Type UnspecifiedGROUP PRACTICE