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General NPI Number Information
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NPI Number | 1619119948
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Entity Type | Organization
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Legal Business Name | CRYSTAL RIVER EYE CENTER,LLC
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 295 SE US HIGHWAY 19
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-4880
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Country | US
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Telephone | 216-338-7773
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Fax | 352-563-2598
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Provider Business Mailing Address
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Address Line | PO BOX 3979
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City | SARASOTA
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State | FL
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Zip | 34230-3979
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Country | US
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Telephone | 523-795-6622
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Fax | 352-563-2598
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | REGINA I WEBB
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Credential |
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Telephone | 352-795-6622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | ME61395
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME061395
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License Number State | FL
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