MEDICARE: SUNCOAST EYEHEALTH P.A.

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	152W00000X	Optometrist		FL
2	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000P9	OTHER	FL	000P9

General Provider Information

NPI Number	:	1689996969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNCOAST EYEHEALTH P.A.

Provider Business Mailing Address
First Line	:	101 CAPRI ISLES BLVD STE 101
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34292-3209
Country	:	US
Telephone Number	:	941-485-4868
Fax Number	:	941-300-5898

Provider Business Practice Location Address
First Line	:	101 CAPRI ISLES BLVD STE 101
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34292-3209
Country	:	US
Telephone Number	:	941-485-4868
Fax Number	:	941-300-5898

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MELISSA BLACK
Credential	:	O.D.
Telephone Number	:	941-485-4868

Provider Enumeration Date	:	02/27/2010
Last Update Date	:	04/14/2026

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Directions to “SUNCOAST EYEHEALTH P.A. ” Practice Location

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