Provider Demographics
NPI:1982825790
Name:SOUTHWEST FLORIDA EYE CARE LLC
Entity Type:Organization
Organization Name:SOUTHWEST FLORIDA EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLORENTINO
Authorized Official - Middle Name:E
Authorized Official - Last Name:PALMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-768-0006
Mailing Address - Street 1:6850 INTERNATIONAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7129
Mailing Address - Country:US
Mailing Address - Phone:239-768-0006
Mailing Address - Fax:236-768-0850
Practice Address - Street 1:11176 TAMIAMI TRL N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1640
Practice Address - Country:US
Practice Address - Phone:239-594-0124
Practice Address - Fax:239-594-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66932207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266893901Medicaid
FL4960510003Medicare NSC
FLK4267Medicare PIN