Healthcare Provider Details

I. General information

NPI: 1386710937
Provider Name (Legal Business Name): MONTGOMERY EYE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NEAPOLITAN WAY
NAPLES FL
34103-8570
US

IV. Provider business mailing address

1360 E VENICE AVE
VENICE FL
34285-9066
US

V. Phone/Fax

Practice location:
  • Phone: 239-261-8383
  • Fax: 239-261-8443
Mailing address:
  • Phone: 941-480-2020
  • Fax: 941-484-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number999
License Number StateFL

VIII. Authorized Official

Name: ANGIE LIBERTINI
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 941-480-2135