Provider Demographics
NPI:1578834099
Name:DR. PAUL J CONE EYE PA
Entity Type:Organization
Organization Name:DR. PAUL J CONE EYE PA
Other - Org Name:DR. PAUL J CONE OD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-743-1311
Mailing Address - Street 1:961 CESERY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-5607
Mailing Address - Country:US
Mailing Address - Phone:904-743-1311
Mailing Address - Fax:904-743-2802
Practice Address - Street 1:961 CESERY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5607
Practice Address - Country:US
Practice Address - Phone:904-743-1311
Practice Address - Fax:904-743-2802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC-912152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
593674223OtherTRICARE SOUTH REGION
410046556OtherRAILROAD MEDICARE
FL593157258OtherTRICARE
FLP01185759OtherRAILROAD MEDICARE
FL084457800Medicaid
FL66703OtherDAVIS VISION
FL12770OtherOPTUM HEALTH VISION
FL19510OtherBCBSFL
DT7879OtherRAILROAD MEDICARE
FL084457800Medicaid
FLFU579AMedicare PIN
593674223OtherTRICARE SOUTH REGION
FL6150830001Medicare NSC
FL12770OtherOPTUM HEALTH VISION