Provider Demographics
NPI:1467991950
Name:NORTH FLORIDA VISION GROUP INC
Entity Type:Organization
Organization Name:NORTH FLORIDA VISION GROUP INC
Other - Org Name:TRILLIUM EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOROBEVA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-379-5450
Mailing Address - Street 1:14866 OLD SAINT AUGUSTINE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-2611
Mailing Address - Country:US
Mailing Address - Phone:904-379-5450
Mailing Address - Fax:
Practice Address - Street 1:14866 OLD SAINT AUGUSTINE RD STE 110
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2611
Practice Address - Country:US
Practice Address - Phone:904-379-5450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4592152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty