Healthcare Provider Details

I. General information

NPI: 1477524239
Provider Name (Legal Business Name): JAMES KEVIN BELVILLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 STATE ROAD 60 E
LAKE WALES FL
33853-4240
US

IV. Provider business mailing address

403 VONDERBURG DR
BRANDON FL
33511-5501
US

V. Phone/Fax

Practice location:
  • Phone: 863-676-7624
  • Fax: 863-678-0268
Mailing address:
  • Phone: 813-681-1122
  • Fax: 813-684-4924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberC42711
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number72389
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME90641
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number14789
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: