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General NPI Number Information
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NPI Number | 1376553925
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Entity Type | Organization
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Legal Business Name | CAPE CORAL EYE CENTER, P.A.
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 06/06/2012
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Provider Practice Location Address
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Address Line | 4120 DEL PRADO BLVD S
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City | CAPE CORAL
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State | FL
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Zip | 33904-7165
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Country | US
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Telephone | 239-542-2020
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Fax | 239-541-1492
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Provider Business Mailing Address
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Address Line | P.O. BOX 101427
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City | CAPE CORAL
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State | FL
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Zip | 33910
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Country | US
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Telephone | 239-540-8718
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Fax | 239-945-0847
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Authorized Official
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Title or Position | OWNER
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Name | DR. FARRELL C TYSON II
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Credential | M.D.
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Telephone | 239-542-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number | 808
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License Number State | FL
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