Provider Demographics
NPI:1285085985
Name:ST LUCYS EYE INSTITUTE OF OVIEDO LLC
Entity type:Organization
Organization Name:ST LUCYS EYE INSTITUTE OF OVIEDO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVECCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-459-1181
Mailing Address - Street 1:2106 N ORANGE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5509
Mailing Address - Country:US
Mailing Address - Phone:407-459-1181
Mailing Address - Fax:321-732-8440
Practice Address - Street 1:1975 S JOHN YOUNG PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-0603
Practice Address - Country:US
Practice Address - Phone:407-392-2020
Practice Address - Fax:352-289-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-24
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty