1194820571 NPI number — EYE CENTER OF NORTH FLORIDA, P.A.

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 1194820571 NPI number — EYE CENTER OF NORTH FLORIDA, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE CENTER OF NORTH FLORIDA, 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:
CHIPLEY OFFICE
Provider Other Organization Name Type Code:
5
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:
1194820571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 MARTIN LUTHER KING JR BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PANAMA CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32405-4412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-522-7951
Provider Business Mailing Address Fax Number:
850-522-9829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHIPLEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32428-6943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-638-7333
Provider Business Practice Location Address Fax Number:
850-638-9727
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NICHOLS
Authorized Official First Name:
KATHI
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
850-784-3937

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WL0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X ; 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: "N" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: CG6943 . This is a "RR MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1740213529 . This is a "GROUP NPI NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 257952902 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 45154B . This is a "BLUE CROSS & BLUE SHEILD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 114961100 . 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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