MEDICARE: CALOOSA EYE CENTER PA

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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1376581959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALOOSA EYE CENTER PA

Provider Business Mailing Address
First Line	:	1560 MATTHEW DR
Second Line	:	SUITE G
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1702
Country	:	US
Telephone Number	:	239-278-4733
Fax Number	:	239-278-4730

Provider Business Practice Location Address
First Line	:	1560 MATTHEW DR
Second Line	:	SUITE G
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1702
Country	:	US
Telephone Number	:	239-278-4733
Fax Number	:	239-278-4730

Authorized Official
Title or Position	:	OWNER
Name	:	PARNA SHENOY
Credential	:	MD
Telephone Number	:	239-278-4733

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	05/20/2008

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Directions to “CALOOSA EYE CENTER PA ” Practice Location

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