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General NPI Number Information
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NPI Number | 1760786602
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE EYECARE, INC.
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Dates
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Enumeration Date | 01/07/2011
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Last Update Date | 11/18/2013
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Provider Practice Location Address
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Address Line | 12620-3 BEACH BLVD #212
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City | JACKSONVILLE
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State | FL
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Zip | 32246-7130
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Country | US
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Telephone | 954-816-1371
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Fax |
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Provider Business Mailing Address
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Address Line | 12620-3 BEACH BLVD #212
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City | JACKSONVILLE
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State | FL
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Zip | 32246-7130
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Country | US
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Telephone | 954-816-1371
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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. GERARD JOSEPH BALSKI
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Credential | O.D.
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Telephone | 954-816-1371
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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 | OPC 4294
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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 | OPC 4263
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License Number State | FL
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