Provider Demographics
NPI:1942362140
Name:EYE CENTERS OF FLORIDA
Entity Type:Organization
Organization Name:EYE CENTERS OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-939-3456
Mailing Address - Street 1:4101 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9310
Mailing Address - Country:US
Mailing Address - Phone:239-939-3456
Mailing Address - Fax:239-939-3456
Practice Address - Street 1:3507 LEE BLVD
Practice Address - Street 2:STE 104
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1304
Practice Address - Country:US
Practice Address - Phone:239-369-5884
Practice Address - Fax:239-369-7320
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CENTERS OF FLORIDA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-14
Last Update Date:2019-04-17
Deactivation Date:2015-07-17
Deactivation Code:
Reactivation Date:2019-04-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0375090008Medicare NSC