Healthcare Provider Details

I. General information

NPI: 1275535726
Provider Name (Legal Business Name): EYE CENTER OF ST AUGUSTINE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 US HIGHWAY 1 S
ST AUGUSTINE FL
32084-4211
US

IV. Provider business mailing address

1400 US HIGHWAY 1 S
ST AUGUSTINE FL
32084-4211
US

V. Phone/Fax

Practice location:
  • Phone: 904-829-2286
  • Fax:
Mailing address:
  • Phone: 904-829-2286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: PAUL W HUND III
Title or Position: PRESIDENT
Credential: MD
Phone: 904-829-2286