Provider Demographics
NPI:1710185798
Name:ST JOHNS EYE ASSOCIATES PA
Entity Type:Organization
Organization Name:ST JOHNS EYE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAROKH
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPADIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-287-9137
Mailing Address - Street 1:161 HAMPTON POINT DR STE 3
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3058
Mailing Address - Country:US
Mailing Address - Phone:904-287-9137
Mailing Address - Fax:904-287-9057
Practice Address - Street 1:161 HAMPTON POINT DR
Practice Address - Street 2:SUITE 3
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3057
Practice Address - Country:US
Practice Address - Phone:904-287-9137
Practice Address - Fax:904-287-9057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620801100Medicaid
FL620800200Medicaid
FL620801100Medicaid
FLK4203Medicare PIN
FLU85905Medicare UPIN