Provider Demographics
NPI:1396897591
Name:AFFILIATED EYE SPECIALISTS P A
Entity type:Organization
Organization Name:AFFILIATED EYE SPECIALISTS P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-740-0331
Mailing Address - Street 1:331 N MAITLAND AVE
Mailing Address - Street 2:STE B2
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4753
Mailing Address - Country:US
Mailing Address - Phone:407-740-0331
Mailing Address - Fax:407-539-2747
Practice Address - Street 1:331 N MAITLAND AVE
Practice Address - Street 2:STE B2
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4753
Practice Address - Country:US
Practice Address - Phone:407-740-0331
Practice Address - Fax:407-539-2747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMD0047068174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1226932007OtherCIGNA
72948OtherBLUE CROSS BLUE SHIELD
CA9128OtherRAILROAD MEDICARE
2001142OtherAETNA
FL72948OtherMEDICARE PTAN
FL039944200Medicaid
13551OtherGHI
FL96809OtherBLUE CROSS BLUE SHIELD IND
72948OtherBLUE CROSS BLUE SHIELD
2001142OtherAETNA
FL039944200Medicaid
FL0979570001Medicare NSC