Provider Demographics
NPI:1992770176
Name:FLORIDA EYE CLINIC P A
Entity type:Organization
Organization Name:FLORIDA EYE CLINIC P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-834-7776
Mailing Address - Street 1:160 BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4706
Mailing Address - Country:US
Mailing Address - Phone:407-339-0303
Mailing Address - Fax:407-339-0961
Practice Address - Street 1:5727 CANTON CV
Practice Address - Street 2:#111
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5033
Practice Address - Country:US
Practice Address - Phone:407-695-2020
Practice Address - Fax:407-699-5666
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA EYE CLINIC P A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-21
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL208488107Medicaid
FL99259GMedicare PIN
FL208488107Medicaid