MEDICARE: JACKSONVILLE EYECARE, 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
1	152W00000X	Optometrist	OPC 4294	FL
2	152W00000X	Optometrist	OPC 4263	FL

General Provider Information

NPI Number	:	1760786602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSONVILLE EYECARE, INC.

Provider Business Mailing Address
First Line	:	12620-3 BEACH BLVD #212
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-7130
Country	:	US
Telephone Number	:	954-816-1371
Fax Number	:

Provider Business Practice Location Address
First Line	:	12620-3 BEACH BLVD #212
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-7130
Country	:	US
Telephone Number	:	954-816-1371
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GERARD JOSEPH BALSKI
Credential	:	O.D.
Telephone Number	:	954-816-1371

Provider Enumeration Date	:	01/07/2011
Last Update Date	:	11/18/2013

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