Provider Demographics
NPI:1184197394
Name:UNIVERSITY EYE CENTER, LLC
Entity Type:Organization
Organization Name:UNIVERSITY EYE CENTER, LLC
Other - Org Name:UNF EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:L
Authorized Official - Middle Name:
Authorized Official - Last Name:L
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-620-4393
Mailing Address - Street 1:8 UNF DR STE 238
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-7699
Mailing Address - Country:US
Mailing Address - Phone:904-853-0767
Mailing Address - Fax:
Practice Address - Street 1:8 UNF DR STE 238
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-7699
Practice Address - Country:US
Practice Address - Phone:904-853-0767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
No156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic AssistantGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ML5087944OtherDEPT OF JUSTICE DEA