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Organization
THAYER EYE CARE PA
Active
Organization
THAYER EYE CARE PA
Active
Other names
THAYER EYE CARE CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN R THAYER OD (PRESIDENT-OWNER)
(863) 465-4904
Entity
Organization
Contact information
Practice address
27 US 27 S, LAKE PLACID, FL 33852-7916
(863) 465-4904
(863) 465-4650
Mailing address
27 US 27 S, LAKE PLACID, FL 33852-7916
(863) 465-4904
(863) 465-4650
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19418
BCBS OF FL
FL
01
—
CM2511
RR MEDICARE
FL
Enumeration date
11/14/2006
Last updated
09/19/2011
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