# PALM COAST EYE CENTER, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053365056
- **Authorized official:** LISA RENEE NICHOLS (PRACTICE MANAGER)
- **Authorized official phone:** (941) 794-2020

## Contact information

- **Practice address:** 3131 S TAMIAMI TRL, SUITE 201, SARASOTA, FL 34239-5101
- **Practice address phone:** (941) 954-2020
- **Practice address fax:** (941) 953-3937
- **Mailing address:** 5601 21ST AVE W, BRADENTON, FL 34209-5642
- **Mailing address phone:** (941) 794-2020
- **Mailing address fax:** (941) 792-3464

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OPC3917 | FL | — |
| 207W00000X | Ophthalmology Physician | ME0045451 | FL | Yes |

## Other

- **Enumeration date:** 05/22/2006
- **Last updated:** 04/10/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | CJ5917 | RAILROAD MEDICARE GROUP | FL |