MEDICARE: EYE CARE SPECIALISTS OF FLORDIA 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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1659563211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CARE SPECIALISTS OF FLORDIA LLC

Provider Business Mailing Address
First Line	:	1124 CYPRESS GLEN CIR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-7559
Country	:	US
Telephone Number	:	407-483-0328
Fax Number	:	407-483-0329

Provider Business Practice Location Address
First Line	:	1124 CYPRESS GLEN CIR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-7559
Country	:	US
Telephone Number	:	407-294-5551
Fax Number	:	407-294-5572

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SAIRA A CHOUDHRI
Credential	:	MD
Telephone Number	:	407-483-0328

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	03/12/2020

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