NPIMap

Organization Active NPI

Mid Florida Eye Center PA

  • Ophthalmology Physician
  • Mount Dora, FL
National Provider Identifier
1710980883
Registry record updated Feb 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MID FLORIDA EYE CENTER PA
Practice address
17560 US Highway 441
Mount Dora, FL 32757-6711
Phone
(352) 735-2020
NPI assigned
May 23, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2020

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

Authorized official

Name
George L Neal
Title
President
Phone
(469) 214-0144

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

17560 US Highway 441
Mount Dora, FL 32757-6711

Mailing address

17560 Highway 441
Mount Dora, FL 32757-6711
Phone (352) 735-2020

Other identifiers 1

IdentifierTypeStateIssuer
376541500MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050924000157 FL Part B Supplier - Clinic/Group Practice 4385678747 Receives reassigned benefits from 12 practitioners
5 other NPIs on this enrollment
Practice locations: Wildwood, FL; Summerfield, FL; Leesburg, FL; Mount Dora, FL
O20251104002441 FL DME Supplier - Physician - OphthalmologyDME Supplier - Physician - Optometrist 4385678747 Practice locations: Mount Dora, FL

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Mid Florida Eye Center PA5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

12 S Park Ave
Apopka, FL 32703
Phone (407) 801-7775

17556 SE 109th Terrace Rd
Summerfield, FL 34491
Phone (352) 347-2100

17560 SE 109th Terrace Rd
Summerfield, FL 34491
Phone (352) 735-7855

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580860800000",
    "number": "1710980883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17560 HIGHWAY 441",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327576711",
            "telephone_number": "352-735-2020",
            "fax_number": "352-735-3233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17560 US HIGHWAY 441",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327576711",
            "telephone_number": "352-735-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID FLORIDA EYE CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A",
        "authorized_official_last_name": "NEAL",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "469-214-0144"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "376541500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Dora, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.