MEDICARE: HAPPY EYES, P.A.

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
1	152W00000X	Optometrist	OPC 4100	FL

General Provider Information

NPI Number	:	1326347279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAPPY EYES, P.A.

Provider Business Mailing Address
First Line	:	9525 CROSSHILL BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32222-5812
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9525 CROSSHILL BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32222-5812
Country	:	US
Telephone Number	:	904-573-9482
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST/PRESIDENT
Name	:	AMANDA HILL
Credential	:
Telephone Number	:	904-376-0843

Provider Enumeration Date	:	03/17/2011
Last Update Date	:	03/17/2011

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