Organization
CENTRAL FLORIDA PREMIER EYE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ARIANA BEDOYA (CREDENTIALING SPECIALIST)
(727) 755-0693
Entity
Organization
Contact information
Practice address
8101 CR 466, SUITE 102, LADY LAKE, FL 32159
(352) 253-5961
Mailing address
311 PARK PLACE BLVD, SUITE 500, CLEARWATER, FL 33759-4904
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
ME59804
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054257100
—
FL
Enumeration date
02/04/2016
Last updated
02/04/2016
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