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General NPI Number Information
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NPI Number | 1568465573
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Entity Type | Organization
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Legal Business Name | GOROVOY M D EYE SPECIALISTS P A
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 08/26/2011
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Provider Practice Location Address
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Address Line | 12381 S CLEVELAND AVE STE 300
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City | FORT MYERS
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State | FL
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Zip | 33907-3852
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Country | US
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Telephone | 239-939-1444
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Fax | 239-936-7710
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Provider Business Mailing Address
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Address Line | 12381 S CLEVELAND AVE STE 300
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City | FORT MYERS
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State | FL
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Zip | 33907-3852
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Country | US
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Telephone | 239-939-1444
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Fax | 239-936-7710
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 840342
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License Number State | FL
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