Provider Demographics
NPI:1487980967
Name:EYE SPECIALISTS OF MID FLORIDA, PA
Entity type:Organization
Organization Name:EYE SPECIALISTS OF MID FLORIDA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-294-3504
Mailing Address - Street 1:5032 US HIGHWAY 27 N
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-1354
Mailing Address - Country:US
Mailing Address - Phone:863-382-3900
Mailing Address - Fax:863-385-7442
Practice Address - Street 1:5032 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1354
Practice Address - Country:US
Practice Address - Phone:863-382-3900
Practice Address - Fax:863-385-7442
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE SPECIAISTS OF MID FLORIDA, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-19
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32357207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0585110005Medicare NSC