Provider Demographics
NPI:1265668842
Name:EMERALD COAST EYE CARE
Entity Type:Organization
Organization Name:EMERALD COAST EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PAYTON
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-832-3421
Mailing Address - Street 1:1714 W 23RD ST
Mailing Address - Street 2:SUITE K
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2932
Mailing Address - Country:US
Mailing Address - Phone:850-215-9101
Mailing Address - Fax:850-215-9102
Practice Address - Street 1:1714 W 23RD ST
Practice Address - Street 2:SUITE K
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2932
Practice Address - Country:US
Practice Address - Phone:850-215-9101
Practice Address - Fax:850-215-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4373152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6323570001OtherPTAN