Healthcare Provider Details

I. General information

NPI: 1720894819
Provider Name (Legal Business Name): ATLANTIC EYE INSTITUTE P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 NATURE WALK PKWY UNIT 105
ST AUGUSTINE FL
32092-4903
US

IV. Provider business mailing address

3316 3RD ST S STE 103
JACKSONVILLE BEACH FL
32250-6090
US

V. Phone/Fax

Practice location:
  • Phone: 904-241-7865
  • Fax: 904-421-7435
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

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