Healthcare Provider Details

I. General information

NPI: 1285609461
Provider Name (Legal Business Name): FLORIDA EYE CLINIC P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1089 W GRANADA BLVD #4
ORMOND BEACH FL
32174-8299
US

IV. Provider business mailing address

160 BOSTON AVE
ALTAMONTE SPRINGS FL
32701-4706
US

V. Phone/Fax

Practice location:
  • Phone: 386-676-1300
  • Fax: 386-372-5073
Mailing address:
  • Phone: 407-339-0303
  • Fax: 407-339-0961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: HARRY PAPPAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 407-834-7776