Healthcare Provider Details

I. General information

NPI: 1396858098
Provider Name (Legal Business Name): GOROVOY MD EYE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12381 S CLEVELAND AVE SUITE #300
FORT MYERS FL
33907-3893
US

IV. Provider business mailing address

12381 S CLEVELAND AVE SUITE #300
FORT MYERS FL
33907-3893
US

V. Phone/Fax

Practice location:
  • Phone: 239-939-1444
  • Fax: 239-936-7710
Mailing address:
  • Phone: 239-939-1444
  • Fax: 239-936-7710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number840342
License Number StateFL

VIII. Authorized Official

Name: DR. MARK S. GOROVOY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 239-939-1444