Healthcare Provider Details

I. General information

NPI: 1356072219
Provider Name (Legal Business Name): AUSTIN THOMAS ISAAC MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 HAND AVE STE B3
ORMOND BEACH FL
32174-1140
US

IV. Provider business mailing address

238 EAGLE HARBOR WAY
DAYTONA BEACH FL
32124-1023
US

V. Phone/Fax

Practice location:
  • Phone: 904-564-2020
  • Fax: 904-518-3297
Mailing address:
  • Phone: 678-920-4721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME179818
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: