Provider Demographics
NPI:1841884731
Name:EYE MD OF NICEVILLE SURGERY LLC
Entity type:Organization
Organization Name:EYE MD OF NICEVILLE SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTTIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-489-8720
Mailing Address - Street 1:1480 HICKORY ST STE 106
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-8843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1480 HICKORY ST STE 106
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8843
Practice Address - Country:US
Practice Address - Phone:850-760-0520
Practice Address - Fax:850-760-0501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE M.D. OF NICEVILLE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical