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General NPI Number Information
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NPI Number | 1699081067
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Entity Type | Organization
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Legal Business Name | NORTH FLORIDA EYE CENTER PA
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Dates
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Enumeration Date | 08/24/2010
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Last Update Date | 08/24/2010
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Provider Practice Location Address
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Address Line | 410 N MAIN ST SUITE 6
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City | CHIEFLAND
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State | FL
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Zip | 32626-0866
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Country | US
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Telephone | 352-493-2634
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Fax | 352-493-2517
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Provider Business Mailing Address
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Address Line | 410 N MAIN ST SUITE 6
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City | CHIEFLAND
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State | FL
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Zip | 32626-0866
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Country | US
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Telephone | 352-493-2634
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Fax | 352-493-2517
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Authorized Official
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Title or Position | OWNER
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Name | MAHER M FANOUS
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Credential | MD
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Telephone | 352-331-7337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | OPC 4437
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License Number State | FL
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