Eyelid Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

1220 Issued in FL

Legal business name

EYELID SURGERY CENTER, LLC

Practice address

15620 New Hampshire CT
Fort Myers, FL 33908-4168

Phone

(239) 481-9995

Fax

(239) 481-9745

NPI assigned

Sep 8, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Robert Duane Martilla, RN, LHRM

Title

Administrator

Phone

(239) 481-9995

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255325080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15620 NEW HAMPSHIRE CT",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339084168",
            "telephone_number": "239-481-9995",
            "fax_number": "239-481-9745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15620 NEW HAMPSHIRE CT",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339084168",
            "telephone_number": "239-481-9995",
            "fax_number": "239-481-9745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYELID SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARTILLA",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "DUANE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "239-481-9995",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN, LHRM"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": "1220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS FLORIDA",
            "identifier": "6J5",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ikechukwu V Ezenwa, PHARM.D., PH.D.

• Ambulatory Surgical Clinic/Center in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Ambulatory Surgical Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.