Provider Demographics
NPI:1972275782
Name:BELLA VISTA EYECARE, LLC
Entity Type:Organization
Organization Name:BELLA VISTA EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:NENETTA MORREALE
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:386-852-3600
Mailing Address - Street 1:1492 POPLAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-3212
Mailing Address - Country:US
Mailing Address - Phone:386-852-3600
Mailing Address - Fax:
Practice Address - Street 1:6373 YOUNGERMAN CIR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-6609
Practice Address - Country:US
Practice Address - Phone:904-573-1383
Practice Address - Fax:904-772-6343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty