Healthcare Provider Details

I. General information

NPI: 1942609094
Provider Name (Legal Business Name): MEDICAL CITY EYE CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E MARKS ST
ORLANDO FL
32803-3819
US

IV. Provider business mailing address

214 E MARKS ST
ORLANDO FL
32803-3819
US

V. Phone/Fax

Practice location:
  • Phone: 407-841-6220
  • Fax: 407-423-2285
Mailing address:
  • Phone: 407-841-6220
  • Fax: 407-423-2285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC1134
License Number StateFL

VIII. Authorized Official

Name: MR. GARY R HARDEY
Title or Position: CEO
Credential:
Phone: 321-984-3200