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General NPI Number Information
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NPI Number | 1669545737
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Entity Type | Organization
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Legal Business Name | DOCTORS EYECARE CENTER OF SW FLORIDA, LLC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 5995 S POINTE BLVD STE 111
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City | FORT MYERS
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State | FL
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Zip | 33919-3273
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Country | US
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Telephone | 239-482-0355
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Fax | 239-482-8930
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Provider Business Mailing Address
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Address Line | 5995 S POINTE BLVD STE 111
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City | FORT MYERS
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State | FL
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Zip | 33919-3273
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Country | US
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Telephone | 239-482-0355
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Fax | 239-482-8930
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | TIMOTHY E. UNDERHILL
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Credential | O.D.
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Telephone | 239-482-0355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC001100
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License Number State | FL
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