MEDICARE: HARRIS WILCOX AND DONOVAN P A

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	152W00000X	Optometrist
2	174400000X	Specialist
3	332H00000X	Eyewear Supplier
4	207W00000X	Ophthalmology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CB1273	OTHER	FL	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1710019435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRIS WILCOX AND DONOVAN P A

Provider Business Mailing Address
First Line	:	1855 EASTWEST PKWY
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-6348
Country	:	US
Telephone Number	:	904-272-2020
Fax Number	:	904-272-5762

Provider Business Practice Location Address
First Line	:	1855 EASTWEST PKWY
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-6348
Country	:	US
Telephone Number	:	904-272-2020
Fax Number	:	904-272-5762

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ERIC J KING
Credential	:
Telephone Number	:	904-272-2020

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	11/05/2021

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Directions to “HARRIS WILCOX AND DONOVAN P A ” Practice Location

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