Healthcare Provider Details

I. General information

NPI: 1124063359
Provider Name (Legal Business Name): EYE ASSOCIATES OF GAINESVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 NW 41ST ST
GAINESVILLE FL
32606-6630
US

IV. Provider business mailing address

2521 NW 41ST ST
GAINESVILLE FL
32606-6630
US

V. Phone/Fax

Practice location:
  • Phone: 352-377-7733
  • Fax: 352-244-0681
Mailing address:
  • Phone: 352-377-7733
  • Fax: 352-244-0681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RODERICK F GONZALEZ
Title or Position: ADMINISTRATOR
Credential: RISK MANAGER
Phone: 352-377-7733