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Organization
WEST COAST EYE INSTITUTE PA
Active
Organization
WEST COAST EYE INSTITUTE PA
Active
Parent organization
WEST COAST EYE INSTITUTE PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
WEST COAST EYE INSTITUTE PA
Authorized official
DR. DAN G MONTGOMERY M.D. (VICE PRESIDENT)
(352) 726-6633
Entity
Organization
Contact information
Practice address
830 MEDICAL CT E, INVERNESS, FL 34452-4612
(352) 726-6633
(352) 726-9793
Mailing address
830 MEDICAL CT E, INVERNESS, FL 34452-4612
(352) 726-6633
(352) 726-9793
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME0042680
FL
207W00000X
Ophthalmology Physician
ME0049134
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3784060602
—
FL
01
—
40218A
BLUE CROSS/BLUE SHIELD
FL
Enumeration date
09/01/2006
Last updated
02/08/2010
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