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Organization

MACULA AND DIABETIC EYE CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
PETER G LIVINGSTON M.D. (PRESIDENT)
(941) 539-6779
Entity
Organization

Contact information

Practice address
4916 26TH ST W, STE 200, BRADENTON, FL 34207-1712
(941) 567-4078
(941) 896-7878
Mailing address
4916 26TH ST W, STE 200, BRADENTON, FL 34207-1712
(941) 567-4078
(941) 896-7878

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME102736
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
AN586Z
MEDICARE PTAN
Enumeration date
10/06/2009
Last updated
03/24/2011
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