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General NPI Number Information
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NPI Number | 1639677214
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Entity Type | Organization
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Legal Business Name | FIRST COAST VISION CARE PA
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Dates
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Enumeration Date | 01/29/2018
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 12100 LEM TURNER RD
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City | JACKSONVILLE
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State | FL
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Zip | 32218-2304
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Country | US
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Telephone | 904-764-3801
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Fax | 904-764-3761
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Provider Business Mailing Address
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Address Line | 4133 EAGLE LANDING PKWY
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City | ORANGE PARK
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State | FL
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Zip | 32065-2634
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Country | US
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Telephone |
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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. CHANDRA M WILLIAMS
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Credential | O.D.
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Telephone | 334-467-9776
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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 | 4196
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License Number State | FL
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