Healthcare Provider Details

I. General information

NPI: 1407820962
Provider Name (Legal Business Name): WINTER HAVEN SEBRING FL OPHTHALMOLOGY ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 AVENUE K SE
WINTER HAVEN FL
33880-4126
US

IV. Provider business mailing address

1A BURTON HILLS BLVD STE 300
NASHVILLE TN
37215-6153
US

V. Phone/Fax

Practice location:
  • Phone: 863-294-3504
  • Fax: 863-298-9034
Mailing address:
  • Phone: 615-240-3820
  • Fax: 615-234-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number959
License Number StateFL

VIII. Authorized Official

Name: MR. JEFFREY SNODGRASS
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283