Provider Demographics
NPI:1255434643
Name:SUNCOAST EYE CENTER PA
Entity type:Organization
Organization Name:SUNCOAST EYE CENTER PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-868-9442
Mailing Address - Street 1:14003 LAKESHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7124
Mailing Address - Country:US
Mailing Address - Phone:727-868-9442
Mailing Address - Fax:727-862-6210
Practice Address - Street 1:14003 LAKESHORE BLVD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7124
Practice Address - Country:US
Practice Address - Phone:727-868-9442
Practice Address - Fax:727-862-6210
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNCOAST EYE CENTER PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-07
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066452900Medicaid