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General NPI Number Information
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NPI Number | 1467991950
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Entity Type | Organization
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Legal Business Name | NORTH FLORIDA VISION GROUP INC
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Dates
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Enumeration Date | 02/16/2017
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Last Update Date | 04/12/2021
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Provider Practice Location Address
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Address Line | 14866 OLD SAINT AUGUSTINE RD STE 110
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City | JACKSONVILLE
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State | FL
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Zip | 32258-2611
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Country | US
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Telephone | 904-379-5450
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Fax |
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Provider Business Mailing Address
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Address Line | 14866 OLD SAINT AUGUSTINE RD STE 110
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City | JACKSONVILLE
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State | FL
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Zip | 32258-2611
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Country | US
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Telephone | 904-379-5450
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. ALEXANDRA VOROBEVA
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Credential | OD
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Telephone | 904-379-5450
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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 | OPC4592
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License Number State | FL
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