Organization
CAPE CORAL EYE CENTER, P.A.
Active
Organization
CAPE CORAL EYE CENTER, P.A.
Active
Other names
Eye Surgery & Laser Center, P.A.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FARRELL C TYSON II M.D. (OWNER)
(239) 542-2020
Entity
Organization
Contact information
Practice address
4120 DEL PRADO BLVD S, CAPE CORAL, FL 33904-7165
(239) 542-2020
(239) 541-1492
Mailing address
P.O. BOX 101427, CAPE CORAL, FL 33910
(239) 540-8718
(239) 945-0847
Taxonomy
Speciality
Code
Description
License number
State
261QS0132X
Ophthalmologic Surgery Clinic/Center
Primary
808
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
079051600
—
FL
01
—
2242484
AETNA HMO
FL
01
—
490001086
RR MEDICARE
FL
01
—
61Z
BC/BS
FL
01
—
N221470
STAYWELL MEDICAID
FL
Enumeration date
08/08/2006
Last updated
06/06/2012
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