Provider Demographics
NPI:1790845337
Name:NORTH FLORIDA REGIONAL EYECARE, PA
Entity Type:Organization
Organization Name:NORTH FLORIDA REGIONAL EYECARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-893-4005
Mailing Address - Street 1:1400 VILLAGE SQUARE BLVD
Mailing Address - Street 2:SUITE 3-165
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1250
Mailing Address - Country:US
Mailing Address - Phone:850-222-3937
Mailing Address - Fax:850-877-0206
Practice Address - Street 1:1905 CAPITAL CIR NE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4421
Practice Address - Country:US
Practice Address - Phone:850-222-3937
Practice Address - Fax:850-893-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24269OtherBCBS GROUP NUMBER
FL620174100Medicaid
FL24269OtherBCBS GROUP NUMBER
FL24269AMedicare PIN