Provider Demographics
NPI:1801950647
Name:EAST FLORIDA EYE INSTITUTE PA
Entity type:Organization
Organization Name:EAST FLORIDA EYE INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:ERIC PRENTIS
Authorized Official - Last Name:FRENKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-287-9000
Mailing Address - Street 1:PO BOX 896
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-0896
Mailing Address - Country:US
Mailing Address - Phone:772-287-9000
Mailing Address - Fax:772-287-0507
Practice Address - Street 1:509 SE RIVERSIDE DR
Practice Address - Street 2:SUITE 302
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2579
Practice Address - Country:US
Practice Address - Phone:772-287-9000
Practice Address - Fax:772-287-0507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1135850001Medicare NSC