Healthcare Provider Details

I. General information

NPI: 1710980883
Provider Name (Legal Business Name): MID FLORIDA EYE CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17560 US HIGHWAY 441
MOUNT DORA FL
32757-6711
US

IV. Provider business mailing address

17560 HIGHWAY 441
MOUNT DORA FL
32757-6711
US

V. Phone/Fax

Practice location:
  • Phone: 352-735-2020
  • Fax:
Mailing address:
  • Phone: 352-735-2020
  • Fax: 352-735-3233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE L NEAL
Title or Position: PRESIDENT
Credential:
Phone: 469-214-0144