# FORT MYERS EYE CENTER INC

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

## Provider details

- **NPI number:** 1740480870
- **Authorized official:** DR. BRADLEY DAVID MIDDAUGH O.D. (PRESIDENT)
- **Authorized official phone:** (239) 481-7799

## Contact information

- **Practice address:** 1537 BRANTLEY RD, UNIT A2, FORT MYERS, FL 33907-3923
- **Practice address phone:** (239) 481-7799
- **Practice address fax:** (239) 481-3739
- **Mailing address:** 1537 BRANTLEY RD, UNIT A2, FORT MYERS, FL 33907-3923
- **Mailing address phone:** (239) 481-7799
- **Mailing address fax:** (239) 481-3739

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OPC0002377 | FL | Yes |

## Other

- **Enumeration date:** 07/18/2007
- **Last updated:** 06/20/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 078638100 | — | FL |
| 01 | — | 410041706 | MEDICARE OTHER | FL |