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Organization
CAPE CORAL EYE CENTER, P.A.
Active
Organization
CAPE CORAL EYE CENTER, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FARRELL C. TYSON M.D. (OWNER)
(239) 542-2020
Entity
Organization
Contact information
Practice address
4120 DEL PRADO BLVD, CAPE CORAL, FL 33904-7165
(239) 542-2020
(239) 541-1492
Mailing address
P.O. BOX 101427, CAPE CORAL, FL 33910
(239) 542-2020
(239) 945-0847
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
PH17490
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0008202825
AETNS PPO
FL
01
—
0551882
AETNA HMO
FL
01
—
10D0293672
CLIA
FL
05
—
267723700
—
FL
01
—
72668
BC/BS
FL
01
—
C13047
RR MEDICARE
FL
Enumeration date
08/07/2006
Last updated
09/27/2011
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