# CAPE CORAL EYE CENTER, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427067438
- **Authorized official:** DR. FARRELL C. TYSON M.D. (OWNER)
- **Authorized official phone:** (239) 542-2020

## Contact information

- **Practice address:** 4120 DEL PRADO BLVD, CAPE CORAL, FL 33904-7165
- **Practice address phone:** (239) 542-2020
- **Practice address fax:** (239) 541-1492
- **Mailing address:** P.O. BOX 101427, CAPE CORAL, FL 33910
- **Mailing address phone:** (239) 542-2020
- **Mailing address fax:** (239) 945-0847

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | PH17490 | FL | Yes |

## Other

- **Enumeration date:** 08/07/2006
- **Last updated:** 09/27/2011

## 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 |