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General NPI Number Information
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NPI Number | 1932484276
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Entity Type | Organization
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Legal Business Name | FLORIDA FAMILY EYE CARE, P.A.
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 6225 E STATE ROAD 64 ATTN: VISION CENTER
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City | BRADENTON
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State | FL
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Zip | 34208-6244
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Country | US
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Telephone | 941-748-3611
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Fax |
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Provider Business Mailing Address
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Address Line | 6225 E STATE ROAD 64 ATTN: VISION CENTER
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City | BRADENTON
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State | FL
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Zip | 34208-6244
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Country | US
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Telephone | 941-748-3611
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEAN G CONSIGLIO
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Credential | O.D.
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Telephone | 941-748-3611
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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 | OPC2798
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License Number State | FL
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