Provider Demographics
NPI:1952464828
Name:ABERNATHY SHORTRIDGE INC
Entity Type:Organization
Organization Name:ABERNATHY SHORTRIDGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHORTRIDGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:LDO
Authorized Official - Phone:904-355-6245
Mailing Address - Street 1:1001 PARK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3907
Mailing Address - Country:US
Mailing Address - Phone:904-355-6245
Mailing Address - Fax:904-353-8904
Practice Address - Street 1:1001 PARK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3907
Practice Address - Country:US
Practice Address - Phone:904-355-6245
Practice Address - Fax:904-353-8904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00274156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========1Medicare ID - Type UnspecifiedOCULARIST
FL=========1Medicare ID - Type UnspecifiedOPTICIAN
FL=========1Medicare ID - Type UnspecifiedCONTACT LENS FITTER