Healthcare Provider Details

I. General information

NPI: 1619286267
Provider Name (Legal Business Name): ORBITAL AND OCULO FACIAL CONSULTANTS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2068 HAWTHORNE ST SUITE 201
SARASOTA FL
34239-2307
US

IV. Provider business mailing address

2088 HAWTHORNE ST
SARASOTA FL
34239-2307
US

V. Phone/Fax

Practice location:
  • Phone: 941-870-2057
  • Fax: 941-870-3608
Mailing address:
  • Phone: 941-870-2057
  • Fax: 941-870-3608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID E NOVAK
Title or Position: ADMINISTRATOR
Credential:
Phone: 941-870-2057