| |
936 Bichara Blvd, Lady Lake, FL 32159-7714 | |
(352) 753-9888 | |
(352) 753-0947 |
Full Name | |
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Type | Facility |
Speciality | Ophthalmology |
Location | 936 Bichara Blvd, Lady Lake, Florida |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1285670117 | NPI | - | NPPES |
99816 | Other | FL | BLUE CROSS BLUE SHIELD |
180030274 | Other | MEDICARE RR GROUP ID | |
251540700 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | OPC2612 (Florida) | Secondary |
207W00000X | Ophthalmology | ME0071525 (Florida) | Primary |
207W00000X | Ophthalmology | ME89546 (Florida) | Secondary |
Provider Name | Mamdouh Zeini |
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Provider Type | Practitioner - Ophthalmology |
Provider Identifiers | NPI Number: 1184794372 PECOS PAC ID: 0143288837 Enrollment ID: I20100819000305 |
Mailing Address | Practice Location Address |
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936 Bichara Blvd, Lady Lake, FL 32159-7714 Ph: (352) 753-9888 | 936 Bichara Blvd, Lady Lake, FL 32159-7714 Ph: (352) 753-9888 |