Provider Demographics
NPI:1043249543
Name:DONAGHY, ERIC J (OD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:DONAGHY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 IMMOKALEE RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1401
Mailing Address - Country:US
Mailing Address - Phone:239-592-5511
Mailing Address - Fax:239-592-9259
Practice Address - Street 1:1435 IMMOKALEE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1401
Practice Address - Country:US
Practice Address - Phone:239-592-5511
Practice Address - Fax:239-592-9259
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2618152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU39777Medicare UPIN
FL20406XMedicare PIN