MEDICARE: EYE SPECIALISTS OF MID FLORIDA, PA

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	ME32357	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0585110003	OTHER		DMERC

General Provider Information

NPI Number	:	1760718936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE SPECIALISTS OF MID FLORIDA, PA

Provider Business Mailing Address
First Line	:	407 AVENUE K SE
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-4126
Country	:	US
Telephone Number	:	863-294-3504
Fax Number	:	863-294-8305

Provider Business Practice Location Address
First Line	:	1050 US HIGHWAY 27
Second Line	:	SUITE 1
City	:	CLERMONT
State	:	FL
Zip	:	34714-7508
Country	:	US
Telephone Number	:	352-394-8705
Fax Number	:	352-394-2074

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL WELCH
Credential	:	M.D.
Telephone Number	:	863-294-3504

Provider Enumeration Date	:	10/23/2009
Last Update Date	:	02/27/2013

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