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General NPI Number Information
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NPI Number | 1033200241
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Entity Type | Organization
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Legal Business Name | ATLANTIC EYE INSTITUTE, P.A.
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 3316 3RD ST S STE 103
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-6090
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Country | US
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Telephone | 904-595-5122
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Fax | 904-249-2352
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Provider Business Mailing Address
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Address Line | 3316 3RD ST S SUITE 103
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-6073
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Country | US
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Telephone | 904-241-7865
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Fax |
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Authorized Official
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Title or Position | CHIEF REVENUE OFFICER
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Name | CANDICE B DAVIS
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Credential |
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Telephone | 916-990-7590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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