Provider Demographics
NPI:1447420443
Name:GATEWAY VISION, INC
Entity Type:Organization
Organization Name:GATEWAY VISION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GRIMSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-768-9196
Mailing Address - Street 1:5238-17 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-5005
Mailing Address - Country:US
Mailing Address - Phone:904-768-9196
Mailing Address - Fax:904-765-4301
Practice Address - Street 1:5238-17 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-5005
Practice Address - Country:US
Practice Address - Phone:904-768-9196
Practice Address - Fax:904-765-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC0002051152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty