Provider Demographics
NPI:1669545737
Name:DOCTORS EYECARE CENTER OF SW FLORIDA, LLC
Entity type:Organization
Organization Name:DOCTORS EYECARE CENTER OF SW FLORIDA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:UNDERHILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:239-482-0355
Mailing Address - Street 1:5995 S POINTE BLVD
Mailing Address - Street 2:STE 111
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3273
Mailing Address - Country:US
Mailing Address - Phone:239-482-0355
Mailing Address - Fax:239-482-8930
Practice Address - Street 1:5995 S POINTE BLVD
Practice Address - Street 2:STE 111
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3273
Practice Address - Country:US
Practice Address - Phone:239-482-0355
Practice Address - Fax:239-482-8930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078232700Medicaid
FL620835500Medicaid
FL0490960001Medicare NSC