Provider Demographics
NPI:1154537504
Name:FLORIDA EYE CENTER PA
Entity type:Organization
Organization Name:FLORIDA EYE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-895-2020
Mailing Address - Street 1:1515 9TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1224
Mailing Address - Country:US
Mailing Address - Phone:727-895-2020
Mailing Address - Fax:727-823-8796
Practice Address - Street 1:1515 9TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1224
Practice Address - Country:US
Practice Address - Phone:727-895-2020
Practice Address - Fax:727-823-8796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
FL601418332B00000X
FLME30852332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263741300Medicaid
FL270596600Medicaid
FL56403600Medicaid
FL39453000Medicaid
FL54314400Medicaid
FL272314000Medicaid
FL620696400Medicaid
FL84235400Medicaid
FL39453000Medicaid
FL84235400Medicaid
FL620696400Medicaid
FL54314400Medicaid
FL263741300Medicaid
FLD57982Medicare UPIN
FLD05887Medicare UPIN
FL270596600Medicaid