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General NPI Number Information
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NPI Number | 1528393717
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Entity Type | Organization
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Legal Business Name | BEACHES EYE CENTER, PA
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Dates
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Enumeration Date | 10/06/2009
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Last Update Date | 08/01/2018
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Provider Practice Location Address
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Address Line | 1351 13TH AVE S SUITE 120-A
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250
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Country | US
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Telephone | 904-246-3937
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Fax | 904-242-0415
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Provider Business Mailing Address
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Address Line | 1351 13TH AVE S SUITE 120-A
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-3234
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Country | US
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Telephone | 904-246-3937
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Fax | 904-242-0415
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD DWIGHT TEN HULZEN
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Credential | M.D.
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Telephone | 904-246-3937
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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 | ME0080332
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License Number State | FL
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