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General NPI Number Information
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NPI Number | 1417269549
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Entity Type | Organization
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Legal Business Name | FIRST COAST EYE ASSOCIATES, PA
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 07/06/2010
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Provider Practice Location Address
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Address Line | 11900 ATLANTIC BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32225-2920
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Country | US
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Telephone | 904-996-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 2527 CIMARRONE BLVD
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City | SAINT JOHNS
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State | FL
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Zip | 32259-2186
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Country | US
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Telephone | 904-996-0200
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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. PATRICK J DOMINGO
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Credential | O.D.
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Telephone | 904-996-0200
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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 | OPC3440
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC3445
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License Number State | FL
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