Provider Demographics
NPI:1508983370
Name:BAILEY EYE CARE, INC.
Entity Type:Organization
Organization Name:BAILEY EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:386-965-5205
Mailing Address - Street 1:2074 SW SISTERS WELCOME RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-1603
Mailing Address - Country:US
Mailing Address - Phone:386-965-5205
Mailing Address - Fax:
Practice Address - Street 1:6868 US HIGHWAY 129
Practice Address - Street 2:VISION CENTER
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060-8476
Practice Address - Country:US
Practice Address - Phone:386-965-5205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP0003121152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20828ZMedicare ID - Type Unspecified