MEDICARE: TOMOKA EYE ASSOCIATES, P.A.

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
1	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1376595835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOMOKA EYE ASSOCIATES, P.A.

Provider Business Mailing Address
First Line	:	21 HOSPITAL DR
Second Line	:	SUITE 160
City	:	PALM COAST
State	:	FL
Zip	:	32164-2452
Country	:	US
Telephone Number	:	386-586-3711
Fax Number	:	386-586-3788

Provider Business Practice Location Address
First Line	:	21 HOSPITAL DR
Second Line	:	SUITE 160
City	:	PALM COAST
State	:	FL
Zip	:	32164-2454
Country	:	US
Telephone Number	:	386-586-3711
Fax Number	:	386-586-3788

Authorized Official
Title or Position	:	OFFICE/BILLING MANAGER
Name	:	ALLISON KERN
Credential	:
Telephone Number	:	386-506-8403

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	03/06/2020

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