Provider Demographics
NPI:1639528532
Name:PRECISION EYEWEAR OF WOLCHOK EYE, LLC
Entity Type:Organization
Organization Name:PRECISION EYEWEAR OF WOLCHOK EYE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOLCHOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-739-0606
Mailing Address - Street 1:3636 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE A2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4250
Mailing Address - Country:US
Mailing Address - Phone:904-990-3937
Mailing Address - Fax:904-739-0609
Practice Address - Street 1:3636 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE A2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4250
Practice Address - Country:US
Practice Address - Phone:904-990-3937
Practice Address - Fax:904-739-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7554200001Medicare PIN