MEDICARE: CAPE CORAL EYE CENTER, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1114321502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPE CORAL EYE CENTER, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 101427
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33910-1427
Country	:	US
Telephone Number	:	239-542-2020
Fax Number	:	239-541-1492

Provider Business Practice Location Address
First Line	:	3925 BONITA BEACH RD
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-4112
Country	:	US
Telephone Number	:	239-947-6000
Fax Number	:	239-947-3914

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/ OWNER
Name	:	DR. FARRELL C TYSON
Credential	:	M.D.
Telephone Number	:	239-542-2020

Provider Enumeration Date	:	10/15/2014
Last Update Date	:	10/15/2014

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