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General NPI Number Information
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NPI Number | 1356382725
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Entity Type | Organization
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Legal Business Name | OPHTHALMIC FACIAL PLASTIC SURGERY SPECIALISTS
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 7331 COLLEGE PARKWAY SUITE 200
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City | FORT MYERS
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State | FL
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Zip | 33907
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Country | US
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Telephone | 239-947-4042
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Fax | 239-390-9976
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Provider Business Mailing Address
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Address Line | 7331 COLLEGE PARKWAY SUITE 200
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City | FORT MYERS
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State | FL
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Zip | 33907
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Country | US
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Telephone | 239-947-4042
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Fax | 239-390-9976
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN JOSEPH LAQUIS
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Credential | MD
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Telephone | 239-947-4042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME82974
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State | FL
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