Provider Demographics
NPI:1598560880
Name:AEG FLORIDA PROFESSIONAL PLLC
Entity type:Organization
Organization Name:AEG FLORIDA PROFESSIONAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR MVC
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-741-8183
Mailing Address - Street 1:111 E 4TH ST STE 440
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6206
Mailing Address - Country:US
Mailing Address - Phone:314-741-8183
Mailing Address - Fax:
Practice Address - Street 1:7208 W SAND LAKE RD STE 202
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5278
Practice Address - Country:US
Practice Address - Phone:407-271-8931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty