Provider Demographics
NPI:1346383270
Name:ATLANTIC EYE INSTITUTE P A
Entity Type:Organization
Organization Name:ATLANTIC EYE INSTITUTE P A
Other - Org Name:ATLANTIC OPTICAL BEACHES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHMUNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-595-5122
Mailing Address - Street 1:3316 3RD ST S
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-6073
Mailing Address - Country:US
Mailing Address - Phone:904-241-2990
Mailing Address - Fax:
Practice Address - Street 1:3316 3RD ST S
Practice Address - Street 2:SUITE 103
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-6073
Practice Address - Country:US
Practice Address - Phone:904-241-2990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC EYE INSTITUTE, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-14
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3983050002Medicare NSC