Provider Demographics
NPI:1902468838
Name:MERLINO EYE ASSOCIATES PA
Entity Type:Organization
Organization Name:MERLINO EYE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MERLINO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-482-1241
Mailing Address - Street 1:12438 BRISTOL COMMONS CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2409
Mailing Address - Country:US
Mailing Address - Phone:813-482-1241
Mailing Address - Fax:
Practice Address - Street 1:13128 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-4858
Practice Address - Country:US
Practice Address - Phone:833-209-7114
Practice Address - Fax:352-515-0750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014669400Medicaid