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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
1152W00000XOptometristOPC0002051FL

General Provider Information

NPI Number : 1447420443
Entity Type Code : Organization
Provider Name (Legal Business Name) : GATEWAY VISION, INC
Provider Business Mailing Address
First Line : 5238-17 NORWOOD AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32208-5005
Country : US
Telephone Number : 904-768-9196
Fax Number : 904-765-4301
Provider Business Practice Location Address
First Line : 5238-17 NORWOOD AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32208-5005
Country : US
Telephone Number : 904-768-9196
Fax Number : 904-765-4301
Authorized Official
Title or Position : OWNER
Name : DR. RICHARD SCOTT GRIMSHAW
Credential : O.D.
Telephone Number : 904-768-9196
Provider Enumeration Date : 03/05/2008
Last Update Date : 03/05/2008

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Directions to “GATEWAY VISION, INC ” Practice Location

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