Healthcare Provider Details

I. General information

NPI: 1679386908
Provider Name (Legal Business Name): CENTRAL FLORIDA EYE SPECIALISTS PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S GROVE ST
EUSTIS FL
32726-5524
US

IV. Provider business mailing address

500 ROSS ST 154-0455 BOX 360579
PITTSBURGH PA
15262-0001
US

V. Phone/Fax

Practice location:
  • Phone: 352-227-1999
  • Fax: 352-227-1001
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CANDICE B DAVIS
Title or Position: CHIEF REVENUE CYCLE OFFICER
Credential:
Phone: 916-990-7590