Healthcare Provider Details

I. General information

NPI: 1588735708
Provider Name (Legal Business Name): FILUTOWSKI EYE INSTITUTE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 GREENWOOD BLVD
LAKE MARY FL
32746-5404
US

IV. Provider business mailing address

110 YORKTOWNE DR
DAYTONA BEACH FL
32119-1471
US

V. Phone/Fax

Practice location:
  • Phone: 407-333-5111
  • Fax: 407-333-2434
Mailing address:
  • Phone: 386-788-6696
  • Fax: 386-788-2219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1054
License Number StateFL

VIII. Authorized Official

Name: KONRAD W FILUTOWSKI
Title or Position: PRESIDENT AND MEDICAL DIRECTOR
Credential: MD
Phone: 407-333-5111