MEDICARE: RETINA HEALTH CENTER PL

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
2	207WX0107X	Retina Specialist (Ophthalmology) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427064039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETINA HEALTH CENTER PL

Provider Business Mailing Address
First Line	:	1567 HAYLEY LN
Second Line	:	SUITE 101
City	:	FORT MYERS
State	:	FL
Zip	:	33907-2109
Country	:	US
Telephone Number	:	239-337-3337
Fax Number	:	239-936-2394

Provider Business Practice Location Address
First Line	:	1567 HAYLEY LN
Second Line	:	SUITE 101
City	:	FORT MYERS
State	:	FL
Zip	:	33907-2109
Country	:	US
Telephone Number	:	239-337-3337
Fax Number	:	239-936-2394

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALEXANDER M EATON
Credential	:	MD
Telephone Number	:	239-337-3337

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	12/14/2017

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