# WEST COAST EYE INSTITUTE PA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WEST COAST EYE INSTITUTE PA
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1336241462
- **Legal business name:** WEST COAST EYE INSTITUTE PA
- **Authorized official:** DR. DAN G MONTGOMERY M.D. (VICE PRESIDENT)
- **Authorized official phone:** (352) 726-6633

## Contact information

- **Practice address:** 830 MEDICAL CT E, INVERNESS, FL 34452-4612
- **Practice address phone:** (352) 726-6633
- **Practice address fax:** (352) 726-9793
- **Mailing address:** 830 MEDICAL CT E, INVERNESS, FL 34452-4612
- **Mailing address phone:** (352) 726-6633
- **Mailing address fax:** (352) 726-9793

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | ME0042680 | FL | Yes |
| 207W00000X | Ophthalmology Physician | ME0049134 | FL | — |

## Other

- **Enumeration date:** 09/01/2006
- **Last updated:** 02/08/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3784060602 | — | FL |
| 01 | — | 40218A | BLUE CROSS/BLUE SHIELD | FL |