Provider Demographics
NPI:1104971423
Name:FLORIDA EYE MICROSURGICAL INSTITUTE INC
Entity type:Organization
Organization Name:FLORIDA EYE MICROSURGICAL INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF REVENUE CYCLE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-990-7590
Mailing Address - Street 1:500 ROSS ST 154-0455 BOX 392985
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15262-0001
Mailing Address - Country:US
Mailing Address - Phone:561-737-5500
Mailing Address - Fax:561-737-7055
Practice Address - Street 1:1717 W WOOLBRIGHT RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6319
Practice Address - Country:US
Practice Address - Phone:561-737-5500
Practice Address - Fax:561-737-7055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800020175207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0930940001Medicare NSC
FL24460Medicare ID - Type UnspecifiedMEDICARE NUMBER