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General NPI Number Information
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NPI Number | 1770770398
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Entity Type | Organization
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Legal Business Name | SOUTHERN EYE INSTITUTE
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 05/09/2019
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Provider Practice Location Address
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Address Line | 720 N OCEAN ST
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City | JACKSONVILLE
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State | FL
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Zip | 32202-3043
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Country | US
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Telephone | 904-355-0115
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Fax | 904-355-5602
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Provider Business Mailing Address
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Address Line | 720 N OCEAN ST
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City | JACKSONVILLE
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State | FL
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Zip | 32202-3043
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Country | US
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Telephone | 904-355-0115
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Fax | 904-355-5602
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STUART DAVID FELDMAN
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Credential | D.O.
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Telephone | 904-355-0115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OS6694
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License Number State | FL
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