Healthcare Provider Details

I. General information

NPI: 1568136349
Provider Name (Legal Business Name): NEURO-OPHTHALMOLOGY AND STRABISMUS CONSULTANTS OF SOUTHWEST FLORIDA P
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9776 BONITA BEACH RD SE STE 202B
BONITA SPRINGS FL
34135-4775
US

IV. Provider business mailing address

2338 IMMOKALEE RD # 203
NAPLES FL
34110-1445
US

V. Phone/Fax

Practice location:
  • Phone: 239-308-0063
  • Fax:
Mailing address:
  • Phone: 239-919-4342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCI L CHARLAND
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 231-638-1853