MEDICARE: EYES ON OAKLEAF, 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	OPC3588	FL

General Provider Information

NPI Number	:	1326372061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYES ON OAKLEAF, P A

Provider Business Mailing Address
First Line	:	9560 CROSSHILL BLVD STE 106
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32222-5827
Country	:	US
Telephone Number	:	904-777-2927
Fax Number	:	904-777-4047

Provider Business Practice Location Address
First Line	:	9560 CROSSHILL BLVD STE 106
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32222-5827
Country	:	US
Telephone Number	:	904-777-2927
Fax Number	:	904-777-4047

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. HANAA MALIK HABASHI
Credential	:	O.D.
Telephone Number	:	904-994-0458

Provider Enumeration Date	:	09/29/2009
Last Update Date	:	11/27/2009

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Directions to “EYES ON OAKLEAF, P A ” Practice Location

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