Healthcare Provider Details

I. General information

NPI: 1245347327
Provider Name (Legal Business Name): PIEDMONT OPHTHALMOLOGY CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 NE JENSEN BEACH BLVD
JENSEN BEACH FL
34957-4754
US

IV. Provider business mailing address

746 NE JENSEN BEACH BLVD
JENSEN BEACH FL
34957-4754
US

V. Phone/Fax

Practice location:
  • Phone: 434-250-6270
  • Fax:
Mailing address:
  • Phone: 434-250-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELISSA H GAMMON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 434-799-3232