Provider Demographics
NPI:1962416511
Name:FLORIDA EYE CONSULTANTS INC
Entity type:Organization
Organization Name:FLORIDA EYE CONSULTANTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-722-4443
Mailing Address - Street 1:1995 W NASA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-2300
Mailing Address - Country:US
Mailing Address - Phone:321-722-4443
Mailing Address - Fax:321-722-2334
Practice Address - Street 1:1995 W NASA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-2300
Practice Address - Country:US
Practice Address - Phone:321-722-4443
Practice Address - Fax:321-722-2334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21125OtherBC/BS FL
FL255267100Medicaid
FL255267100Medicaid
FLCD2308Medicare PIN
FL1254900002Medicare NSC