1033200241 NPI number — ATLANTIC EYE INSTITUTE, P.A.

Table of content: (NPI 1033200241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033200241 NPI number — ATLANTIC EYE INSTITUTE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTIC EYE INSTITUTE, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033200241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3316 3RD ST S
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
JACKSONVILLE BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32250-6073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-241-7865
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3316 3RD ST S STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32250-6090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-595-5122
Provider Business Practice Location Address Fax Number:
904-249-2352
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RICHMOND
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
904-241-7865

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 024924700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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