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General NPI Number Information
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NPI Number | 1598726325
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Entity Type | Organization
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Legal Business Name | ST MICHAELS EYE & LASER INSTITUTE INC
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 1030 W BAY DR STE 200
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City | LARGO
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State | FL
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Zip | 33770-3276
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Country | US
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Telephone | 727-585-2200
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Fax | 813-697-1758
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Provider Business Mailing Address
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Address Line | 1030 W BAY DR STE 200
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City | LARGO
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State | FL
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Zip | 33770-3276
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Country | US
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Telephone | 727-585-2200
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Fax | 813-697-1758
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | GREGORY L MICHAELOS
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Credential |
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Telephone | 727-585-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2006002749
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License Number State | FL
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