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General NPI Number Information
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NPI Number | 1447420773
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Entity Type | Organization
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Legal Business Name | EYE CONSULTANTS OF BONITA SPRINGS PLLC
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 08/19/2010
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Provider Practice Location Address
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Address Line | 23451 WALDEN CENTER DR
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-4919
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Country | US
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Telephone | 239-949-2021
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Fax |
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Provider Business Mailing Address
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Address Line | 23451 WALDEN CENTER DR
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-4919
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Country | US
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Telephone | 239-949-2021
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | STEPHEN PASCUCCI
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Credential | MD
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Telephone | 239-949-2021
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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 | ME88450
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License Number State | FL
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