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General NPI Number Information
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NPI Number | 1376957571
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Entity Type | Organization
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Legal Business Name | AMELIA EYE ASSOCIATES LLC
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Dates
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Enumeration Date | 06/16/2014
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Last Update Date | 09/12/2014
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Provider Practice Location Address
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Address Line | 1411 S 14TH ST SUITE G
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-3031
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Country | US
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Telephone | 904-321-1333
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Fax | 904-277-1255
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Provider Business Mailing Address
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Address Line | 1411 S 14TH ST SUITE G
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-3031
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Country | US
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Telephone | 904-321-1333
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Fax | 904-277-1255
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. GERALD WILLIAM KOSS II
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Credential | O.D.
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Telephone | 904-321-1333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | OPC4033
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License Number State | FL
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