Healthcare Provider Details

I. General information

NPI: 1841226552
Provider Name (Legal Business Name): NAPLES EYE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 SW HEALTH PKWY SUITE 105
NAPLES FL
34109-0473
US

IV. Provider business mailing address

1890 SW HEALTH PKWY #105
NAPLES FL
34109-0473
US

V. Phone/Fax

Practice location:
  • Phone: 239-598-3653
  • Fax: 239-936-2532
Mailing address:
  • Phone: 239-598-3653
  • Fax: 239-598-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1205
License Number StateFL

VIII. Authorized Official

Name: JOHN W SNEAD
Title or Position: MEMBER
Credential: MD
Phone: 239-598-2712