Healthcare Provider Details

I. General information

NPI: 1760456438
Provider Name (Legal Business Name): FLORIDA EYE CLINIC P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 E RICH AVE
DELAND FL
32724-4357
US

IV. Provider business mailing address

160 BOSTON AVE
ALTAMONTE SPRINGS FL
32701-4706
US

V. Phone/Fax

Practice location:
  • Phone: 386-734-3120
  • Fax: 386-734-3125
Mailing address:
  • Phone: 407-834-7776
  • Fax: 407-834-0973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: GEN PARM
Title or Position: ADMINISTRATOR
Credential:
Phone: 407-834-7776