Provider Demographics
NPI:1427067438
Name:CAPE CORAL EYE CENTER, P.A.
Entity type:Organization
Organization Name:CAPE CORAL EYE CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARRELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-542-2020
Mailing Address - Street 1:P.O. BOX 101427
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33910
Mailing Address - Country:US
Mailing Address - Phone:239-542-2020
Mailing Address - Fax:239-945-0847
Practice Address - Street 1:4120 DEL PRADO BLVD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7165
Practice Address - Country:US
Practice Address - Phone:239-542-2020
Practice Address - Fax:239-541-1492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH17490152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0008202825OtherAETNS PPO
FL10D0293672OtherCLIA
FL72668OtherBC/BS
FL267723700Medicaid
FLC13047OtherRR MEDICARE
FL0551882OtherAETNA HMO
FL72668OtherBC/BS
FL267723700Medicaid