Healthcare Provider Details

I. General information

NPI: 1710394622
Provider Name (Legal Business Name): FLORIDA RETINA SPECIALISTS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2329 MEDICO LN STE 103
MELBOURNE FL
32940-8449
US

IV. Provider business mailing address

280 N SYKES CREEK PKWY STE B
MERRITT ISLAND FL
32953-3491
US

V. Phone/Fax

Practice location:
  • Phone: 321-735-8800
  • Fax: 321-690-2288
Mailing address:
  • Phone: 321-735-8800
  • Fax: 321-735-8898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KACIE O'REILLY
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 321-735-8800