Healthcare Provider Details

I. General information

NPI: 1427067438
Provider Name (Legal Business Name): CAPE CORAL EYE CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 DEL PRADO BLVD
CAPE CORAL FL
33904-7165
US

IV. Provider business mailing address

P.O. BOX 101427
CAPE CORAL FL
33910
US

V. Phone/Fax

Practice location:
  • Phone: 239-542-2020
  • Fax: 239-541-1492
Mailing address:
  • Phone: 239-542-2020
  • Fax: 239-945-0847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberPH17490
License Number StateFL

VIII. Authorized Official

Name: DR. FARRELL C. TYSON
Title or Position: OWNER
Credential: M.D.
Phone: 239-542-2020