Provider Demographics
NPI:1215348123
Name:EYE CARE OF SOUTH WEST FLORIDA LLC
Entity type:Organization
Organization Name:EYE CARE OF SOUTH WEST FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGONA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:239-631-6451
Mailing Address - Street 1:2382 IMMOKALEE RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1446
Mailing Address - Country:US
Mailing Address - Phone:239-631-6451
Mailing Address - Fax:239-631-6455
Practice Address - Street 1:2382 IMMOKALEE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1446
Practice Address - Country:US
Practice Address - Phone:239-631-6451
Practice Address - Fax:239-631-6455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3905152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011934900Medicaid