# PROVISION LASER EYE CENTER PA

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

## Provider details

- **NPI number:** 1184616146
- **Authorized official:** SCOTT P DURRETT MD (OWNER)
- **Authorized official phone:** (941) 493-0311

## Contact information

- **Practice address:** 1191 JACARANDA BLVD, VENICE, FL 34292-4518
- **Practice address phone:** (941) 493-0311
- **Practice address fax:** (941) 492-4655
- **Mailing address:** 1191 JACARANDA BLVD, VENICE, FL 34292-4518
- **Mailing address phone:** (941) 493-0311
- **Mailing address fax:** (941) 492-4655

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/16/2005
- **Last updated:** 12/21/2011