Healthcare Provider Details

I. General information

NPI: 1407608326
Provider Name (Legal Business Name): ECSA OPTICAL COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ZEAGLER DR STE 120
PALATKA FL
32177-3827
US

IV. Provider business mailing address

800 ZEAGLER DR STE 120
PALATKA FL
32177-3827
US

V. Phone/Fax

Practice location:
  • Phone: 386-328-8369
  • Fax: 904-810-5687
Mailing address:
  • Phone: 386-328-8369
  • Fax: 904-810-5687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CANDICE B DAVIS
Title or Position: CHIEF REVENUE CYCLE OFFICER
Credential:
Phone: 916-990-7590