Provider Demographics
NPI:1811990963
Name:FIRST COAST EYEWEAR INC
Entity type:Organization
Organization Name:FIRST COAST EYEWEAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:I
Authorized Official - Last Name:SCHNIPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-355-5555
Mailing Address - Street 1:2001 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3703
Mailing Address - Country:US
Mailing Address - Phone:904-355-5555
Mailing Address - Fax:904-355-9966
Practice Address - Street 1:2001 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3703
Practice Address - Country:US
Practice Address - Phone:904-355-5555
Practice Address - Fax:904-355-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL07702800003332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078661600Medicaid
FLD7173OtherBCBS
FL0502140001Medicare NSC