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General NPI Number Information
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NPI Number | 1598729352
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Entity Type | Organization
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Legal Business Name | FAMILY EYE CARE CENTER OF JACKSONVILLE PA
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 8833 PERIMETER PARK BLVD SUITE 403
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1110
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Country | US
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Telephone | 904-996-7774
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Fax | 904-996-9511
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Provider Business Mailing Address
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Address Line | 8833 PERIMETER PARK BLVD SUITE 403
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1110
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Country | US
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Telephone | 904-996-7774
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Fax | 904-996-9511
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ADAM DAVID KOENIGSBERG
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Credential | MD
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Telephone | 904-996-7774
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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 | ME75604
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License Number State | FL
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