Organization
PALM COAST EYE CENTER, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA RENEE NICHOLS (PRACTICE MANAGER)
(941) 794-2020
Entity
Organization
Contact information
Practice address
5601 21ST AVE W, SUITE A, BRADENTON, FL 34209-5642
(941) 794-2020
(941) 792-3464
Mailing address
5601 21ST AVE W, SUITE A, BRADENTON, FL 34209-5642
(941) 794-2020
(941) 792-3464
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OPC3917
FL
207W00000X
Ophthalmology Physician
Primary
ME0045451
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CJ5917
RAILROAD MEDICARE GROUP
FL
Enumeration date
06/07/2006
Last updated
04/10/2008
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