Organization
CAPE CORAL EYE CENTER, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FARRELL C. TYSON M.D. (OWNER)
(239) 542-2020
Entity
Organization
Contact information
Practice address
4120 DEL PRADO BLVD, CAPE CORAL, FL 33904-7165
(239) 542-2020
(239) 541-1492
Mailing address
P.O. BOX 101427, CAPE CORAL, FL 33910
(239) 542-2020
(239) 945-0847
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
PH17490
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0008202825
AETNS PPO
FL
01
—
0551882
AETNA HMO
FL
01
—
10D0293672
CLIA
FL
05
—
267723700
—
FL
01
—
72668
BC/BS
FL
01
—
C13047
RR MEDICARE
FL
Enumeration date
08/07/2006
Last updated
09/27/2011
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