Healthcare Provider Details

I. General information

NPI: 1740600790
Provider Name (Legal Business Name): WEST COAST EYE INSTITUTE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S APOPKA AVE
INVERNESS FL
34452-4803
US

IV. Provider business mailing address

240 N LECANTO HWY
LECANTO FL
34461-9191
US

V. Phone/Fax

Practice location:
  • Phone: 352-419-8928
  • Fax: 352-746-2807
Mailing address:
  • Phone: 352-746-2246
  • Fax: 352-746-2807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4215
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOPC4215
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOS4322
License Number StateFL

VIII. Authorized Official

Name: JOHN W ROWDA
Title or Position: PRESIDENT
Credential: DO
Phone: 352-746-2246