Provider Demographics
NPI:1881942175
Name:EYECARE AND SURGERY CENTER OF SOUTHWEST FLORIDA, LLC
Entity type:Organization
Organization Name:EYECARE AND SURGERY CENTER OF SOUTHWEST FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:STELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-575-9300
Mailing Address - Street 1:3665 TAMIAMI TRL
Mailing Address - Street 2:#101
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-7200
Mailing Address - Country:US
Mailing Address - Phone:941-575-9300
Mailing Address - Fax:941-575-9394
Practice Address - Street 1:3665 TAMIAMI TRL
Practice Address - Street 2:#101
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-7200
Practice Address - Country:US
Practice Address - Phone:941-575-9300
Practice Address - Fax:941-575-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069687156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF91310Medicare UPIN