Provider Demographics
NPI:1841514320
Name:THE EYE DOCTOR, P.A.
Entity type:Organization
Organization Name:THE EYE DOCTOR, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:EDMUND
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-221-6500
Mailing Address - Street 1:13170 ATLANTIC BLVD
Mailing Address - Street 2:SUITE 53
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-6149
Mailing Address - Country:US
Mailing Address - Phone:904-221-6500
Mailing Address - Fax:904-221-6504
Practice Address - Street 1:13170 ATLANTIC BLVD
Practice Address - Street 2:SUITE 53
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6149
Practice Address - Country:US
Practice Address - Phone:904-221-6500
Practice Address - Fax:904-221-6504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2425152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCX251AMedicare PIN
FLU02322Medicare UPIN
FLDQ3789Medicare PIN
FL20317Medicare PIN