# ADVANCED SURGICAL AND MEDICAL EYE CARE P A

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- **Entity:** Organization
- **Status:** Active
- **Other names:** EYES at The Villages
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285670117
- **Authorized official:** MS. TRACY MICHELLE MASTERS CO, COMT (ADMINISTRATOR)
- **Authorized official phone:** (352) 753-9888

## Contact information

- **Practice address:** 936 BICHARA BLVD, LADY LAKE, FL 32159-7714
- **Practice address phone:** (352) 753-9888
- **Practice address fax:** (352) 753-0947
- **Mailing address:** 936 BICHARA BLVD, LADY LAKE, FL 32159-7714
- **Mailing address phone:** (352) 753-9888
- **Mailing address fax:** (352) 753-0947

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OPC2612 | FL | — |
| 207W00000X | Ophthalmology Physician | ME0071525 | FL | Yes |
| 207W00000X | Ophthalmology Physician | ME89546 | FL | — |

## Other

- **Enumeration date:** 06/20/2006
- **Last updated:** 08/18/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 180030274 | MEDICARE RR GROUP ID | — |
| 05 | — | 251540700 | — | FL |
| 01 | — | 99816 | BLUE CROSS BLUE SHIELD | FL |