=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740600790
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST COAST EYE INSTITUTE PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2014
-----------------------------------------------------
Last Update Date | 04/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 212 S APOPKA AVE
-----------------------------------------------------
City | INVERNESS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34452-4803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-419-8928
-----------------------------------------------------
Fax | 352-746-2807
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 240 N LECANTO HWY
-----------------------------------------------------
City | LECANTO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34461-9191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-746-2246
-----------------------------------------------------
Fax | 352-746-2807
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOHN W ROWDA
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 352-746-2246
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WL0500X
-----------------------------------------------------
Taxonomy Name | Low Vision Rehabilitation Optometrist
-----------------------------------------------------
License Number | OPC4215
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | OS4322
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC4215
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------