Provider Demographics
NPI:1659963205
Name:HARRIS WILCOX AND DONOVAN PA
Entity Type:Organization
Organization Name:HARRIS WILCOX AND DONOVAN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-272-2020
Mailing Address - Street 1:1658 ST VINCENTS WAY STE 250
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-8431
Mailing Address - Country:US
Mailing Address - Phone:904-272-2020
Mailing Address - Fax:904-276-4386
Practice Address - Street 1:1658 ST VINCENTS WAY STE 250
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-8431
Practice Address - Country:US
Practice Address - Phone:904-272-2020
Practice Address - Fax:904-276-4386
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARRIS WILCOX AND DONOVAN P A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCB1273OtherRAILROAD MEDICARE