Provider Demographics
NPI:1215111547
Name:MANATEE FAMILY EYECARE, PA
Entity type:Organization
Organization Name:MANATEE FAMILY EYECARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAQUIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:941-729-5516
Mailing Address - Street 1:501 VILLAGE GREEN PKWY STE 3
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3401
Mailing Address - Country:US
Mailing Address - Phone:941-792-7522
Mailing Address - Fax:
Practice Address - Street 1:1236 JACARANDA BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-4507
Practice Address - Country:US
Practice Address - Phone:941-496-4444
Practice Address - Fax:941-496-4223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDC7823OtherGBA-RAILROAD MEDICARE
FL39527AMedicare PIN