Healthcare Provider Details

I. General information

NPI: 1740397157
Provider Name (Legal Business Name): THE EYE ASSOCIATES OF MANATEE, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 61ST ST W
BRADENTON FL
34209-5528
US

IV. Provider business mailing address

2203 61ST ST W
BRADENTON FL
34209-5528
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-2020
  • Fax: 941-798-3995
Mailing address:
  • Phone: 941-792-2020
  • Fax: 941-798-3995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. ROBERT L. MARSHALL
Title or Position: CHIEF FINANCIAL OFFICER/MANAGING EM
Credential:
Phone: 941-792-2020