Provider Demographics
NPI:1013956986
Name:CENTRAL FLORIDA PREMIER EYE ASSOCIATES
Entity Type:Organization
Organization Name:CENTRAL FLORIDA PREMIER EYE ASSOCIATES
Other - Org Name:LAKE EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WEHRLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-343-4798
Mailing Address - Street 1:1852 MAYO DR
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4320
Mailing Address - Country:US
Mailing Address - Phone:352-343-2020
Mailing Address - Fax:352-343-4728
Practice Address - Street 1:1852 MAYO DR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4320
Practice Address - Country:US
Practice Address - Phone:352-343-2020
Practice Address - Fax:352-343-4728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
98103OtherBLUE CROSS BLUE SHIELD
FL278334700Medicaid
98103OtherBLUE CROSS BLUE SHIELD