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General NPI Number Information
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NPI Number | 1902190895
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Entity Type | Organization
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Legal Business Name | NORTH FLORIDA REGIONAL EYECARE, PA
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 1905 CAPITAL CIR NE
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4421
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Country | US
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Telephone | 850-222-3937
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Fax | 850-877-0206
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Provider Business Mailing Address
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Address Line | 1400 VILLAGE SQUARE BLVD SUITE 3-165
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City | TALLAHASSEE
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State | FL
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Zip | 32312-1250
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Country | US
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Telephone | 850-222-3937
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Fax | 850-877-0206
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES A STEPHENS
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Credential | OD
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Telephone | 850-893-4005
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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 | OPC935
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME71349
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License Number State | FL
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