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General NPI Number Information
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NPI Number | 1740344662
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Entity Type | Organization
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Legal Business Name | EYE SITE OF CAPE CORAL PA
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 08/09/2010
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Provider Practice Location Address
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Address Line | 613 DEL PRADO BLVD S
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City | CAPE CORAL
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State | FL
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Zip | 33990-2611
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Country | US
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Telephone | 239-772-2122
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Fax | 239-772-8183
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Provider Business Mailing Address
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Address Line | 613 DEL PRADO BLVD S
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City | CAPE CORAL
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State | FL
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Zip | 33990-2611
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Country | US
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Telephone | 239-772-2122
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Fax | 239-772-8183
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES EVERETT CROLEY III
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Credential | MD
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Telephone | 239-772-2122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME36184
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License Number State | FL
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