Provider Demographics
NPI:1548274061
Name:EYE INSTITUTE SURGERY CENTER, LLC
Entity type:Organization
Organization Name:EYE INSTITUTE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:N
Authorized Official - Last Name:MCMANUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-749-1446
Mailing Address - Street 1:1995 W NASA BLVD
Mailing Address - Street 2:SUITE100
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-2300
Mailing Address - Country:US
Mailing Address - Phone:321-722-4443
Mailing Address - Fax:321-722-2334
Practice Address - Street 1:1995 W NASA BLVD
Practice Address - Street 2:SUITE100
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-2300
Practice Address - Country:US
Practice Address - Phone:321-722-4443
Practice Address - Fax:321-722-2334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1223261QA1903X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024323200Medicaid
FL759546Medicaid