MEDICARE: SARASOTA OPHTHALMOLOGY ASC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	787	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	490005025	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164495198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARASOTA OPHTHALMOLOGY ASC LLC

Provider Business Mailing Address
First Line	:	3920 BEE RIDGE RD
Second Line	:	BLDG F, SUITE C
City	:	SARASOTA
State	:	FL
Zip	:	34233-1207
Country	:	US
Telephone Number	:	941-925-0000
Fax Number	:	941-927-2726

Provider Business Practice Location Address
First Line	:	3920 BEE RIDGE RD
Second Line	:	BLDG F, SUITE C
City	:	SARASOTA
State	:	FL
Zip	:	34233-1207
Country	:	US
Telephone Number	:	941-925-0000
Fax Number	:	941-927-2726

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. BILLIE A PAYNE
Credential	:
Telephone Number	:	615-665-1283

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	05/06/2009

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