Provider Demographics
NPI:1649427543
Name:SEVIGNY & ASSOCIATES EYE CARE, PA
Entity type:Organization
Organization Name:SEVIGNY & ASSOCIATES EYE CARE, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:SEVIGNY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:863-773-3322
Mailing Address - Street 1:735 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUCHULA
Mailing Address - State:FL
Mailing Address - Zip Code:33873-2002
Mailing Address - Country:US
Mailing Address - Phone:863-773-3322
Mailing Address - Fax:863-773-6458
Practice Address - Street 1:735 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-2002
Practice Address - Country:US
Practice Address - Phone:863-773-3322
Practice Address - Fax:863-773-6458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL152W00000X152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002372600Medicaid
FL002372600Medicaid
FL6499700001Medicare NSC