Healthcare Provider Details

I. General information

NPI: 1457189110
Provider Name (Legal Business Name): FLORIDA EYE INSTITUTE SURGICENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 INDIAN RIVER BLVD
VERO BEACH FL
32960-5225
US

IV. Provider business mailing address

2750 INDIAN RIVER BLVD
VERO BEACH FL
32960-5225
US

V. Phone/Fax

Practice location:
  • Phone: 772-569-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THOMAS ANTHONY BAUDO
Title or Position: OWNER
Credential:
Phone: 772-569-9500