Provider Demographics
NPI:1376685404
Name:ATLANTIC EYE INSTITUTE P A
Entity Type:Organization
Organization Name:ATLANTIC EYE INSTITUTE P A
Other - Org Name:ATLANTIC OPTICAL SOUTHSIDE
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:904-241-7865
Mailing Address - Street 1:6207 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5007
Mailing Address - Country:US
Mailing Address - Phone:904-731-4515
Mailing Address - Fax:
Practice Address - Street 1:6207 BENNETT RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5007
Practice Address - Country:US
Practice Address - Phone:904-731-4515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC EYE INSTITUTE P A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-13
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3983050001Medicare NSC