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Organization
TOTAL EYE CARE SURGERY CENTER INC
Active
Organization
TOTAL EYE CARE SURGERY CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL PENNACHIO M.D. (PRESIDENT)
(352) 728-1717
Entity
Organization
Contact information
Practice address
640 S LAKE ST, LEESBURG, FL 34748-5927
(352) 728-1952
Mailing address
640 S LAKE ST, LEESBURG, FL 34748-5927
(352) 728-1952
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
68S
BCBS
FL
01
—
MCARE RR
490004453
FL
Enumeration date
06/24/2006
Last updated
11/12/2015
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