MEDICARE: EYE CENTER OF NORTH FLORIDA, P.A.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	152WC0802X	Corneal and Contact Management Optometrist
2	152WL0500X	Low Vision Rehabilitation Optometrist
3	152WP0200X	Pediatric Optometrist
4	207W00000X	Ophthalmology Physician
5	332H00000X	Eyewear Supplier
6	152W00000X	Optometrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CG6943	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1740213529	OTHER		GROUP NPI NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	45154B	OTHER	FL	BLUE CROSS & BLUE SHEILD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194820571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CENTER OF NORTH FLORIDA, P.A.

Provider Business Mailing Address
First Line	:	2500 MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4412
Country	:	US
Telephone Number	:	850-522-7951
Fax Number	:	850-522-9829

Provider Business Practice Location Address
First Line	:	1400 MAIN ST
Second Line	:
City	:	CHIPLEY
State	:	FL
Zip	:	32428-6943
Country	:	US
Telephone Number	:	850-638-7333
Fax Number	:	850-638-9727

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. KATHI NICHOLS
Credential	:
Telephone Number	:	850-784-3937

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	04/20/2023

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Directions to “EYE CENTER OF NORTH FLORIDA, P.A. ” Practice Location

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