Organization
TOTAL EYE CARE SURGERY CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL PENNACHIO M.D. (PRESIDENT)
(352) 728-1717
Entity
Organization
Contact information
Practice address
640 S LAKE ST, LEESBURG, FL 34748-5927
(352) 728-1952
Mailing address
640 S LAKE ST, LEESBURG, FL 34748-5927
(352) 728-1952
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
68S
BCBS
FL
01
—
MCARE RR
490004453
FL
Enumeration date
06/24/2006
Last updated
11/12/2015
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