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Organization
ADVANCED SURGICAL AND MEDICAL EYE CARE P A
Active
Organization
ADVANCED SURGICAL AND MEDICAL EYE CARE P A
Active
Other names
EYES at The Villages
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRACY MICHELLE MASTERS CO, COMT (ADMINISTRATOR)
(352) 753-9888
Entity
Organization
Contact information
Practice address
936 BICHARA BLVD, LADY LAKE, FL 32159-7714
(352) 753-9888
(352) 753-0947
Mailing address
936 BICHARA BLVD, LADY LAKE, FL 32159-7714
(352) 753-9888
(352) 753-0947
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OPC2612
FL
207W00000X
Ophthalmology Physician
Primary
ME0071525
FL
207W00000X
Ophthalmology Physician
ME89546
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180030274
MEDICARE RR GROUP ID
—
05
—
251540700
—
FL
01
—
99816
BLUE CROSS BLUE SHIELD
FL
Enumeration date
06/20/2006
Last updated
08/18/2010
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