Healthcare Provider Details

I. General information

NPI: 1295789220
Provider Name (Legal Business Name): EYE PHYSICIANS OF CENTRAL FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W STATE ROAD 434 SUITE 111
LONGWOOD FL
32750-4980
US

IV. Provider business mailing address

225 W STATE ROAD 434 SUITE 111
LONGWOOD FL
32750-4980
US

V. Phone/Fax

Practice location:
  • Phone: 407-767-6411
  • Fax: 407-767-8160
Mailing address:
  • Phone: 407-767-6411
  • Fax: 407-767-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. CHARLA R FERCHOW
Title or Position: ADMINISTRATOR
Credential:
Phone: 407-767-6411