Provider Demographics
NPI:1619718160
Name:MINDFUL EYE HEALTHCARE
Entity type:Organization
Organization Name:MINDFUL EYE HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LYNCH
Authorized Official - Last Name:PHILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-313-2807
Mailing Address - Street 1:1080 SW FENWAY RD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2303
Mailing Address - Country:US
Mailing Address - Phone:561-313-2807
Mailing Address - Fax:
Practice Address - Street 1:1080 SW FENWAY RD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2303
Practice Address - Country:US
Practice Address - Phone:561-313-2807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-06
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty