Healthcare Provider Details

I. General information

NPI: 1164708830
Provider Name (Legal Business Name): ST.JOHN EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 REDHOOK PLAZA STE 225
CHARLOTTE AMALIE VIRGIN ISLAND
00801
UM

IV. Provider business mailing address

6500 REDHOOK PLAZA STE 225
CHARLOTTE AMALIE VIRGIN ISLAND
00801
UM

V. Phone/Fax

Practice location:
  • Phone: 340-779-2019
  • Fax: 340-779-2020
Mailing address:
  • Phone: 340-779-2019
  • Fax: 340-779-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number10416786
License Number StateVI

VIII. Authorized Official

Name: MR. CRAIG FRIEDENBERG
Title or Position: OPTOMETRIST
Credential: O.D
Phone: 340-779-2019