Provider Demographics
NPI:1710019435
Name:HARRIS WILCOX AND DONOVAN P A
Entity Type:Organization
Organization Name:HARRIS WILCOX AND DONOVAN P A
Other - Org Name:CLAY EYE PHYSICIANS AND SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position: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 1:1855 EASTWEST PKWY
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-6348
Mailing Address - Country:US
Mailing Address - Phone:904-272-2020
Mailing Address - Fax:904-272-5762
Practice Address - Street 1:1855 EASTWEST PKWY
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-6348
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, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-09
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCB1273OtherRAILROAD MEDICARE
FL98904Medicare PIN
FL0478560002Medicare NSC