Provider Demographics
NPI:1992846471
Name:GAINESVILLE EYE PHYSICIANS PA
Entity Type:Organization
Organization Name:GAINESVILLE EYE PHYSICIANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BALCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-331-7811
Mailing Address - Street 1:6717 NW 11TH PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4236
Mailing Address - Country:US
Mailing Address - Phone:352-331-7811
Mailing Address - Fax:352-331-3219
Practice Address - Street 1:6717 NW 11TH PL
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4236
Practice Address - Country:US
Practice Address - Phone:352-331-7811
Practice Address - Fax:352-331-3219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50649207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40221AOtherGROUP #
FL1108800001Medicare NSC
FL40221AMedicare PIN
1108800001Medicare PIN