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General NPI Number Information
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NPI Number | 1508182577
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Entity Type | Organization
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Legal Business Name | EYE SPECIALISTS LASER & SURGERY CENTER INC
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 08/26/2011
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Provider Practice Location Address
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Address Line | 12453 S CLEVELAND AVE
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City | FORT MYERS
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State | FL
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Zip | 33907-3828
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Country | US
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Telephone | 239-939-1444
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Fax | 239-275-3332
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Provider Business Mailing Address
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Address Line | 12453 S CLEVELAND AVE
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City | FORT MYERS
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State | FL
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Zip | 33907-3828
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Country | US
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Telephone | 239-939-1444
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Fax | 239-275-3332
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Authorized Official
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Title or Position | MEDICAL DOCTOR/PRESIDENT
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Name | MARK S GOROVOY
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Credential | M.D.
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Telephone | 239-939-1444
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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 |
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License Number State |
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