Healthcare Provider Details

I. General information

NPI: 1104293026
Provider Name (Legal Business Name): EYE ASSOCIATES OF MANATEE, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 E VENICE AVE
VENICE FL
34292-1661
US

IV. Provider business mailing address

PO BOX 162264
ALTAMONTE SPRINGS FL
32716-2264
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-2020
  • Fax: 941-782-1089
Mailing address:
  • Phone: 941-792-2020
  • Fax: 941-782-1089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: KEVIN BECKER
Title or Position: CFO
Credential: CFO
Phone: 706-243-2259