Provider Demographics
NPI:1376957571
Name:AMELIA EYE ASSOCIATES LLC
Entity Type:Organization
Organization Name:AMELIA EYE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KOSS
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:904-321-1333
Mailing Address - Street 1:1411 S 14TH ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3031
Mailing Address - Country:US
Mailing Address - Phone:904-321-1333
Mailing Address - Fax:904-277-1255
Practice Address - Street 1:1411 S 14TH ST
Practice Address - Street 2:SUITE G
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3031
Practice Address - Country:US
Practice Address - Phone:904-321-1333
Practice Address - Fax:904-277-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4033152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty