Provider Demographics
NPI:1992319206
Name:COMMUNITY EYE CENTER PA
Entity type:Organization
Organization Name:COMMUNITY EYE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRSCHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-625-1325
Mailing Address - Street 1:21275 OLEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6703
Mailing Address - Country:US
Mailing Address - Phone:941-625-1325
Mailing Address - Fax:941-625-0131
Practice Address - Street 1:1988 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5001
Practice Address - Country:US
Practice Address - Phone:941-408-0145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY EYE CENTER PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-03
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic SurgeryGroup - Multi-Specialty