Healthcare Provider Details

I. General information

NPI: 1942516588
Provider Name (Legal Business Name): EYE PHYSICIANS AND SURGEONS OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1571 PERIWINKLE WAY
SANIBEL FL
33957-4513
US

IV. Provider business mailing address

4790 BARKLEY CIR BLDG C-103
FORT MYERS FL
33907-7543
US

V. Phone/Fax

Practice location:
  • Phone: 239-472-4204
  • Fax:
Mailing address:
  • Phone: 239-936-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberME41612
License Number StateFL

VIII. Authorized Official

Name: JOHN SNEAD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 239-936-8686