Provider Demographics
NPI:1245482710
Name:FLEMING ISLAND VISION CENTER, INC.
Entity type:Organization
Organization Name:FLEMING ISLAND VISION CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BLALOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-637-2000
Mailing Address - Street 1:1524 COUNTY ROAD 220 STE 5
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4913
Mailing Address - Country:US
Mailing Address - Phone:904-637-2000
Mailing Address - Fax:904-637-2001
Practice Address - Street 1:1524 COUNTY ROAD 220 STE 5
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4913
Practice Address - Country:US
Practice Address - Phone:904-637-2000
Practice Address - Fax:904-637-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3085152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty