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General NPI Number Information
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NPI Number | 1245569508
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Entity Type | Organization
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Legal Business Name | 3D VISION EYE SURGERY CENTER
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Dates
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Enumeration Date | 12/16/2009
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 1201 S RIDGEWOOD AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-6123
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Country | US
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Telephone | 386-492-7718
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Fax | 386-492-7720
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Provider Business Mailing Address
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Address Line | 1201 S RIDGEWOOD AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-6123
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Country | US
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Telephone | 386-492-7718
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Fax | 386-492-7720
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ALLEN THOMAS JACKSON
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Credential | M.D.
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Telephone | 386-492-7718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME80695
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License Number State | FL
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