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General NPI Number Information
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NPI Number | 1841514320
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Entity Type | Organization
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Legal Business Name | THE EYE DOCTOR, P.A.
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Dates
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Enumeration Date | 03/26/2010
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 13170 ATLANTIC BLVD SUITE 53
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City | JACKSONVILLE
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State | FL
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Zip | 32225-6149
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Country | US
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Telephone | 904-221-6500
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Fax | 904-221-6504
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Provider Business Mailing Address
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Address Line | 13170 ATLANTIC BLVD SUITE 53
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City | JACKSONVILLE
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State | FL
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Zip | 32225-6149
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Country | US
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Telephone | 904-221-6500
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Fax | 904-221-6504
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRANK EDMUND HOUSER
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Credential | O.D.
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Telephone | 904-221-6500
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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 | OPC2425
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License Number State | FL
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