Provider Demographics
NPI:1588735708
Name:FILUTOWSKI EYE INSTITUTE PA
Entity type:Organization
Organization Name:FILUTOWSKI EYE INSTITUTE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KONRAD
Authorized Official - Middle Name:W
Authorized Official - Last Name:FILUTOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-333-5111
Mailing Address - Street 1:110 YORKTOWNE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1471
Mailing Address - Country:US
Mailing Address - Phone:386-788-6696
Mailing Address - Fax:386-788-2219
Practice Address - Street 1:1070 GREENWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5404
Practice Address - Country:US
Practice Address - Phone:407-333-5111
Practice Address - Fax:407-333-2434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1054261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0082522OtherGHI
FL10D0928401OtherCLIA
FL68EOtherBCBSFL
FL0768600 00Medicaid
FL68EOtherBCBSFL
FLF1285Medicare PIN