Healthcare Provider Details

I. General information

NPI: 1912310780
Provider Name (Legal Business Name): CAPE CORAL EYE CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 TAMIAMI TRL N STE 304
NAPLES FL
34103-4457
US

IV. Provider business mailing address

PO BOX 101427
CAPE CORAL FL
33910-1427
US

V. Phone/Fax

Practice location:
  • Phone: 239-542-2020
  • Fax: 239-542-0704
Mailing address:
  • Phone: 239-542-2020
  • Fax: 239-541-1492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License NumberME81910
License Number StateFL

VIII. Authorized Official

Name: DR. FARRELL TYSON
Title or Position: MEDICAL DIRECTOR/ OWNER
Credential: MD
Phone: 239-542-2020