Organization
NORTH FLORIDA EYE CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAHER M FANOUS MD (OWNER)
(352) 331-7337
Entity
Organization
Contact information
Practice address
410 N MAIN ST, SUITE 6, CHIEFLAND, FL 32626-0866
(352) 493-2634
(352) 493-2517
Mailing address
410 N MAIN ST, SUITE 6, CHIEFLAND, FL 32626-0866
(352) 493-2634
(352) 493-2517
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
OPC 4437
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
257002500
—
FL
01
—
49379
BCBS OF FL
FL
Enumeration date
08/24/2010
Last updated
08/24/2010
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