Provider Demographics
NPI:1346539988
Name:HARRIS WILCOX AND DONOVAN PA
Entity Type:Organization
Organization Name:HARRIS WILCOX AND DONOVAN PA
Other - Org Name:CLAY EYE PHYSICIANS AND SURGEONS, PA- MANDARIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-272-2020
Mailing Address - Street 1:11790 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1836
Mailing Address - Country:US
Mailing Address - Phone:904-765-2020
Mailing Address - Fax:904-272-5762
Practice Address - Street 1:11790 SAN JOSE BL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223
Practice Address - Country:US
Practice Address - Phone:904-272-2020
Practice Address - Fax:904-272-5762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL152W00000X, 156FC0800X, 174400000X, 207W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCB1273OtherMCR RAILROAD
FL98904OtherMEDICARE GROUP # CLINICAL
FLCB1273OtherMCR RAILROAD
FL0478560003Medicare NSC