MEDICARE: DOCTORS EYECARE CENTER OF SW FLORIDA, LLC

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	OPC001100	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669545737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTORS EYECARE CENTER OF SW FLORIDA, LLC

Provider Business Mailing Address
First Line	:	5995 S POINTE BLVD
Second Line	:	STE 111
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3273
Country	:	US
Telephone Number	:	239-482-0355
Fax Number	:	239-482-8930

Provider Business Practice Location Address
First Line	:	5995 S POINTE BLVD
Second Line	:	STE 111
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3273
Country	:	US
Telephone Number	:	239-482-0355
Fax Number	:	239-482-8930

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	TIMOTHY E. UNDERHILL
Credential	:	O.D.
Telephone Number	:	239-482-0355

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	06/07/2022

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Directions to “DOCTORS EYECARE CENTER OF SW FLORIDA, LLC ” Practice Location

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