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NPI Code Detail

MEDICARE: GATEWAY VISION INC

MEDICARE: GATEWAY VISION INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOPC002051FL

General Provider Information

NPI Number : 1205885886
Entity Type Code : Organization
Provider Name (Legal Business Name) : GATEWAY VISION INC
Provider Business Mailing Address
First Line : 447 ATLANTIC BLVD
Second Line : SUITE # 1
City : ATLANTIC BEACH
State : FL
Zip : 32233-4004
Country : US
Telephone Number : 904-247-0211
Fax Number : 904-246-6115
Provider Business Practice Location Address
First Line : 447 ATLANTIC BLVD
Second Line : SUITE # 1
City : ATLANTIC BEACH
State : FL
Zip : 32233-4004
Country : US
Telephone Number : 904-247-0211
Fax Number : 904-246-6115
Authorized Official
Title or Position : OWNER
Name : DR. RICHARD S GRIMSHAW
Credential : O.D.
Telephone Number : 904-247-0211
Provider Enumeration Date : 05/09/2006
Last Update Date : 08/22/2020

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Directions to “GATEWAY VISION INC ” Practice Location

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