Healthcare Provider Details

I. General information

NPI: 1740213529
Provider Name (Legal Business Name): EYE CENTER OF NORTH FLORIDA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MARTIN LUTHER KING JR BLVD
PANAMA CITY FL
32405-4412
US

IV. Provider business mailing address

2500 MARTIN LUTHER KING JR BLVD
PANAMA CITY FL
32405-4412
US

V. Phone/Fax

Practice location:
  • Phone: 850-784-3937
  • Fax: 850-522-9829
Mailing address:
  • Phone: 850-784-3937
  • Fax: 850-522-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRET L FISHER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 850-784-3937