Healthcare Provider Details

I. General information

NPI: 1194195883
Provider Name (Legal Business Name): RIDGE EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7056 SKYWAY
PARADISE CA
95969-3960
US

IV. Provider business mailing address

311 PARK PLACE BLVD 5TH FLOOR
CLEARWATER FL
33759-4904
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-1900
  • Fax: 530-895-1531
Mailing address:
  • Phone: 727-755-0693
  • Fax: 727-755-0679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MISS JASMINE WORTHEN
Title or Position: CREDETNIALING SPECIALIST
Credential:
Phone: 727-755-0693