Organization
EYELID SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT DUANE MARTILLA RN, LHRM (ADMINISTRATOR)
(239) 481-9995
Entity
Organization
Contact information
Practice address
15620 NEW HAMPSHIRE CT, FORT MYERS, FL 33908-4168
(239) 481-9995
(239) 481-9745
Mailing address
15620 NEW HAMPSHIRE CT, FORT MYERS, FL 33908-4168
(239) 481-9995
(239) 481-9745
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
1220
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6J5
BC/BS FLORIDA
FL
Enumeration date
09/08/2005
Last updated
08/22/2020
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