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NPI Code Detail

MEDICARE: AUSTIN TAYLOR OD

MEDICARE: AUSTIN TAYLOR OD
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
1152W00000XOptometrist6526FL

General Provider Information

NPI Number : 1639910649
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUSTIN TAYLOR OD
Provider Business Mailing Address
First Line : 103 BELL ST
Second Line :
City : HAZLEHURST
State : GA
Zip : 31539-6411
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1100 S PONCE DE LEON BLVD STE 4
Second Line :
City : SAINT AUGUSTINE
State : FL
Zip : 32084-6013
Country : US
Telephone Number : 904-824-0212
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2024
Last Update Date : 07/08/2024

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Directions to “ AUSTIN TAYLOR OD” Practice Location

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