Healthcare Provider Details

I. General information

NPI: 1689904666
Provider Name (Legal Business Name): EYECARE PARTNERS OF SOUTHWEST FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5265 UNIVERSITY PKWY UNIT 101
UNIVERSITY PARK FL
34201-3000
US

IV. Provider business mailing address

5265 UNIVERSITY PKWY UNIT 101
UNIVERSITY PARK FL
34201-3000
US

V. Phone/Fax

Practice location:
  • Phone: 941-441-7581
  • Fax:
Mailing address:
  • Phone: 941-441-7581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPC 1957
License Number StateFL

VIII. Authorized Official

Name: CHARLES ROBERT PUTRINO II
Title or Position: OWNER, SOLE MEMBER
Credential: O.D.
Phone: 941-441-7581