Healthcare Provider Details

I. General information

NPI: 1427064039
Provider Name (Legal Business Name): RETINA HEALTH CENTER PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1567 HAYLEY LN SUITE 101
FORT MYERS FL
33907-2109
US

IV. Provider business mailing address

1567 HAYLEY LN SUITE 101
FORT MYERS FL
33907-2109
US

V. Phone/Fax

Practice location:
  • Phone: 239-337-3337
  • Fax: 239-936-2394
Mailing address:
  • Phone: 239-337-3337
  • Fax: 239-936-2394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEXANDER M EATON
Title or Position: OWNER
Credential: MD
Phone: 239-337-3337