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NPI Code Detail

MEDICARE: HARRIS WILCOX AND DONOVAN PA

MEDICARE: HARRIS WILCOX AND DONOVAN PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist
2156FC0800XContact Lens Technician/Technologist
3174400000XSpecialist
4332H00000XEyewear Supplier
5207W00000XOphthalmology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CB1273OTHERFLRAIL ROAD MEDICARE

General Provider Information

NPI Number : 1023120409
Entity Type Code : Organization
Provider Name (Legal Business Name) : HARRIS WILCOX AND DONOVAN PA
Provider Business Mailing Address
First Line : 2023 PROFESSIONAL CENTER DR
Second Line :
City : ORANGE PARK
State : FL
Zip : 32073-4461
Country : US
Telephone Number : 904-272-2020
Fax Number : 904-272-5762
Provider Business Practice Location Address
First Line : 2023 PROFESSIONAL CENTER DR
Second Line :
City : ORANGE PARK
State : FL
Zip : 32073-4461
Country : US
Telephone Number : 904-272-2020
Fax Number : 904-272-5762
Authorized Official
Title or Position : BILLING REPRESENTATIVE
Name : LUCY DINGMAN
Credential :
Telephone Number : 904-272-2020
Provider Enumeration Date : 08/31/2006
Last Update Date : 06/27/2024

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Directions to “HARRIS WILCOX AND DONOVAN PA ” Practice Location

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