Healthcare Provider Details

I. General information

NPI: 1710185798
Provider Name (Legal Business Name): ST JOHNS EYE ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/21/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 HAMPTON POINT DR SUITE 3
ST AUGUSTINE FL
32092-3057
US

IV. Provider business mailing address

161 HAMPTON POINT DR STE 3
ST AUGUSTINE FL
32092-3058
US

V. Phone/Fax

Practice location:
  • Phone: 904-287-9137
  • Fax: 904-287-9057
Mailing address:
  • Phone: 904-287-9137
  • Fax: 904-287-9057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. SHAROKH KAPADIA
Title or Position: OWNER
Credential: OD
Phone: 904-287-9137