MEDICARE: FORT MYERS EYE CENTER INC

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	OPC0002377	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	410041706	OTHER	FL	MEDICARE OTHER

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	:	1740480870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT MYERS EYE CENTER INC

Provider Business Mailing Address
First Line	:	1537 BRANTLEY RD
Second Line	:	UNIT A2
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3923
Country	:	US
Telephone Number	:	239-481-7799
Fax Number	:	239-481-3739

Provider Business Practice Location Address
First Line	:	1537 BRANTLEY RD
Second Line	:	UNIT A2
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3923
Country	:	US
Telephone Number	:	239-481-7799
Fax Number	:	239-481-3739

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRADLEY DAVID MIDDAUGH
Credential	:	O.D.
Telephone Number	:	239-481-7799

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	06/20/2008

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Directions to “FORT MYERS EYE CENTER INC ” Practice Location

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