Provider Demographics
NPI:1063420172
Name:SECOND SIGHT REHAB PA
Entity type:Organization
Organization Name:SECOND SIGHT REHAB PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIEDECKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:832-541-9186
Mailing Address - Street 1:62 TURKEY CRK
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-9500
Mailing Address - Country:US
Mailing Address - Phone:832-541-9186
Mailing Address - Fax:
Practice Address - Street 1:4101 NW 89TH BLVD
Practice Address - Street 2:SHANDS REHABILITATION HOSPITAL
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-3813
Practice Address - Country:US
Practice Address - Phone:352-265-5491
Practice Address - Fax:352-265-5431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAC275Medicare PIN