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General NPI Number Information
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NPI Number | 1316304983
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Entity Type | Organization
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Legal Business Name | BLUE EYED OCEAN PLLC
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 108 INTRACOASTAL POINTE DR SUITE 100
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City | JUPITER
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State | FL
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Zip | 33477-5036
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Country | US
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Telephone | 561-632-4777
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Fax |
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Provider Business Mailing Address
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Address Line | 1605 S US HIGHWAY 1 UNIT E102
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City | JUPITER
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State | FL
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Zip | 33477-8436
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Country | US
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Telephone | 561-632-4777
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TRACY L HACKETT
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Credential | A.P., DOM, L.AC.
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Telephone | 561-632-4777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | AP3428
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License Number State | FL
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