Provider Demographics
NPI:1811338320
Name:NORTHEAST FLORIDA EYE CARE ASSOCIATES
Entity type:Organization
Organization Name:NORTHEAST FLORIDA EYE CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-446-7009
Mailing Address - Street 1:11406 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-7963
Mailing Address - Country:US
Mailing Address - Phone:904-503-3565
Mailing Address - Fax:904-647-9620
Practice Address - Street 1:359 MARSH LANDING PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-5849
Practice Address - Country:US
Practice Address - Phone:904-280-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty