1043686256 NPI number — HEALTHYEYE DBA VISION EXPRESS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043686256 NPI number — HEALTHYEYE DBA VISION EXPRESS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHYEYE DBA VISION EXPRESS LLC
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:
6
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:
1043686256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4871 TOWN CENTER PARKWAY #5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-686-1386
Provider Business Mailing Address Fax Number:
904-686-1363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4871 TOWN CENTER PARKWAY #5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-686-1386
Provider Business Practice Location Address Fax Number:
904-686-1363
Provider Enumeration Date:
08/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
FALDEN
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
904-686-1386

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 621174700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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