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General NPI Number Information
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NPI Number | 1982845285
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Entity Type | Organization
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Legal Business Name | FLORIDA EYE SPECIALISTS PA
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Dates
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Enumeration Date | 03/16/2009
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Last Update Date | 06/11/2014
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Provider Practice Location Address
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Address Line | 11512 LAKE MEAD AVE SUITE 534
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9680
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Country | US
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Telephone | 904-382-1477
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 1ST ST S SUITE 707
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City | JACKSONVILLE
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State | FL
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Zip | 32250-6443
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Country | US
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Telephone | 904-382-1477
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RAJESH SHETTY
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Credential | M. D.
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Telephone | 904-382-1477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME84552
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License Number State | FL
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