Healthcare Provider Details

I. General information

NPI: 1275740839
Provider Name (Legal Business Name): EYE SURGERY CENTER OF NORTH FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7205 BENTLEY RD
JACKSONVILLE FL
32256-7565
US

IV. Provider business mailing address

PO BOX 11407
BIRMINGHAM AL
35246-8575
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-0098
  • Fax:
Mailing address:
  • Phone: 904-296-0098
  • Fax: 904-293-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KEVIN BECKER
Title or Position: ADMINISTRATOR
Credential: CFO
Phone: 702-432-2594