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General NPI Number Information
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NPI Number | 1710394622
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Entity Type | Organization
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Legal Business Name | FLORIDA RETINA SPECIALISTS, P.A.
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 2329 MEDICO LN STE 103
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City | MELBOURNE
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State | FL
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Zip | 32940-8449
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Country | US
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Telephone | 321-735-8800
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Fax | 321-690-2288
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Provider Business Mailing Address
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Address Line | 280 N SYKES CREEK PKWY STE B
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-3491
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Country | US
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Telephone | 321-735-8800
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Fax | 321-735-8898
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | KACIE O'REILLY
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Credential |
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Telephone | 321-735-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number |
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License Number State |
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