Healthcare Provider Details

I. General information

NPI: 1093120420
Provider Name (Legal Business Name): GAINESVILLE EYE CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 W NEWBERRY RD
GAINESVILLE FL
32605-4338
US

IV. Provider business mailing address

12276 SAN JOSE BLVD SUITE 305
JACKSONVILLE FL
32223-8628
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-6373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: RYAN WILLIAMS
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 904-545-4465