Provider Demographics
NPI:1316098213
Name:TREASURE COAST EYE ASSOCIATES PA
Entity type:Organization
Organization Name:TREASURE COAST EYE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRICE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSELLI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:772-978-0845
Mailing Address - Street 1:333 17TH ST
Mailing Address - Street 2:STE. G
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5670
Mailing Address - Country:US
Mailing Address - Phone:772-978-0845
Mailing Address - Fax:866-562-1117
Practice Address - Street 1:333 17TH ST
Practice Address - Street 2:STE. G
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5670
Practice Address - Country:US
Practice Address - Phone:772-978-0845
Practice Address - Fax:866-562-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3612152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4154Medicare ID - Type UnspecifiedMC GROUP #