Healthcare Provider Details

I. General information

NPI: 1588114730
Provider Name (Legal Business Name): AESTHETIC EYE & SURGICAL ARTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 CLARK RD SUITE 106
SARASOTA FL
34233-3230
US

IV. Provider business mailing address

5310 CLARK RD SUITE 106
SARASOTA FL
34233-3230
US

V. Phone/Fax

Practice location:
  • Phone: 941-921-0400
  • Fax: 941-870-1628
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL BRANNAN
Title or Position: OWNER
Credential: MD
Phone: 941-921-0400