Unknown Individual – Ophthalmology Physician, NPI 1306834213
Excluded from federal healthcare programs (Medicare/Medicaid)
This provider is listed on the OIG List of Excluded Individuals/Entities (LEIE). Exclusion effective: 2013-01-20. Reason: Conviction of program-related crimes (mandatory; min. 5 years).
Ophthalmology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
1034, Mar Walt Drive, Wright, Fort Walton Beach, Okaloosa County, Florida, 32547, United States
SUITE 200
FORT WALTON BEACH, FL 325476639
Phone: (850) 862-4001
Fax: (850) 862-1612
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 32547)
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