Provider Demographics
NPI:1568566024
Name:HARRIS WILCOX AND DONOVAN PA
Entity Type:Organization
Organization Name:HARRIS WILCOX AND DONOVAN PA
Other - Org Name:CLAY EYE PHYSICIANS AND SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-272-2020
Mailing Address - Street 1:2023 PROFESSIONAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4461
Mailing Address - Country:US
Mailing Address - Phone:904-272-2020
Mailing Address - Fax:904-272-5762
Practice Address - Street 1:2023 PROFESSIONAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4461
Practice Address - Country:US
Practice Address - Phone:904-272-2020
Practice Address - Fax:904-272-5762
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARRIS WILCOX AND DONOVAN PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-12
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCB1273Medicare PIN
FL0478560001Medicare NSC
FL98904Medicare PIN