Provider Demographics
NPI:1932718749
Name:EYECARE ASSOCIATES OF SOUTHWEST FLORIDA, PLLC
Entity Type:Organization
Organization Name:EYECARE ASSOCIATES OF SOUTHWEST FLORIDA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:239-451-5954
Mailing Address - Street 1:511 SW 31ST TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-4655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:706 SW PINE ISLAND RD UNIT 102
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-2053
Practice Address - Country:US
Practice Address - Phone:239-451-5954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty