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General NPI Number Information
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NPI Number | 1164570636
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Entity Type | Organization
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Legal Business Name | TRI COUNTY EYE ASSOCIATES PA
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1403 DUNN AVE. UNIT 15
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City | JACKSONVILLE
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State | FL
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Zip | 32218-4870
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Country | US
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Telephone | 904-696-0883
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Fax | 904-696-9283
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Provider Business Mailing Address
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Address Line | 1403 DUNN AVE. UNIT 15
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City | JACKSONVILLE
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State | FL
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Zip | 32218-4870
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Country | US
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Telephone | 904-696-0883
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Fax | 904-696-9283
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Authorized Official
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Title or Position | LAB TECHNICIAN
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Name | DAWN DEBOLLE
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Credential |
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Telephone | 904-696-0883
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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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